In Person Registration


 

Please enter you full mailing address
Would you like to be listed in the Retreat Directory for Outreach? Included will be First Name, Last Initial, Phone Number, Time Zone, Email Address and Best Time to Call
What name would you like on your badge?
What city & state would you like on your badge?
Please list any special needs that we should be aware of.
In which area or areas would you like to be of service?