2024 Registration – Mothers' Retreat

Registation Feb. 23-24,2024

Mothers' Retreat 2024

Name *

First

Last

Address *

Address Line 1

City

State

Zip Code

Phone *

Email *

Email

Confirm Email

Choose Type of Registration (Click on down arrow for options) *

Private Room attendees ONLY Please check the box below if you plan to bring your baby with you to the retreat. (Commuters don't need to check this box)

I plan to bring my baby with me to the retreat.

*PLEASE NOTE THAT CHOOSING A PRIVATE ROOM REGISTRATION ABOVE DOES NOT GUARANTEE THAT A PRIVATE ROOM IS AVAILABLE. The retreat team will contact you by email to let you know if you are confirmed for a private room or if you have been added to the waiting list for a private room. (We maintain a waiting list for private rooms as there are normally a number of cancellations prior to the retreat.)

I have entered an active email address above so that I can be contacted regarding private room availability.

Name for Registration of 2nd Person in Room (IMPORTANT:Second Person Does Not Register Separately) Please be advised that a shared private room has only one full sized bed.

First

Last

Email for Registration of 2nd Person in Room

Email

Confirm Email

In the event that you have been placed on the Waiting List for a Private Room and a room does not become available for you, please let us know how you would like us to adjust your registration (we will refund the difference in registration price as needed.) If no private room becomes available, I will... *

attend the retreat with a Bunk Room Registration.
attend the retreat with a Commuter Registration.
not attend the retreat.

Commuters ONLY (This section should be answered ONLY if you are commuting. Everyone else skip)

I plan on eating breakfast provided by the retreat center
I DO NOT plan on eating breakfast provided by retreat center

Commuters ONLY (This section should be answered ONLY if you are commuting. Everyone else skip)

I plan on attending both Friday AND Saturday
I plan on attending Saturday ONLY

Choose Method of Payment (Private Room reservations made after Feb. 4, recommend paying by check or delayed payment due to potential waiting list status) *

Pay by Check (Make payable to Melissa Jock. Mail to Mothers' Retreat, P.O. Box 555, Sidney, OH 45365)
Credit Card

Total

$0.00

Stripe Credit Card *

Credit Card field is disabled, Stripe payments are not enabled in the form settings.

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