Light of Christ - 2024 Ladies Retreat
If you have any questions, please contact Jessica Hartrich at jessislu@hotmail.com
Personal Information
Name
*
Email
*
This address will receive a confirmation email
Cell Phone
*
Address
*
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Registration Type
*
Please select all that apply.
Early Bird - By 8/15/2024 - $85
After 8/15/2024 - $99
Day Only - $85
Roommate Requests
Bed Preference (e.g. bottom bunk only)
*
Home Church, if any
*
Guest of
Carpool
Carpool Options
*
Please select all that apply.
I need a ride
I can take passengers
I'm driving alone
I'm riding with someone else (specify)
Number of Passengers I can take
If driving, who are you taking with you?
If riding with someone else, who is it?
When can you leave the East Valley?
*
Geographic Area
*
Please select all that apply.
South Gilbert
North Gilbert
Queen Creek
South Chandler
North Chandler
San Tan Valley
East Mesa / AJ
Other - Specify below
Specify Other Geographic Area
Other Information
Comments/Dietary or Other Needs, Allergies, etc.
Payment Options
Payment Type
Early Bird - By 8/15/2024 ($85)
After 8/15/2024 ($99)
Scholarship Needed (Specify) ($0)
Check/Cash (Specify below) ($0)
Early Bird - By 8/15/2024 ($85)
After 8/15/2024 ($99)
Scholarship Needed (Specify) ($0)
Check/Cash (Specify below) ($0)
Amount
Payment Comments
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
Description
If you have any questions, please contact Jessica Hartrich at jessislu@hotmail.com
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