Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

AM Elective Options (Select One) *

Signing led by Charlotte Robinson ($0)

"Pockets of Promises" Craft led by Val McCormick ($4)

Fudge led by Jen Shelenberger ($10)

Applying Colorstreet Nail Sets by Jessica Brand ($13)

Mystery Craft by Beth West ($0)

PM Elective Options (Select One) *

Tea Experience led by Bev Shultz ($0)

Candle Recycling led by Sherry Hutchison ($0 - Please bring old stick candles!)

Prayer Journey led by Diane Rumbaugh ($0 - Please bring your Bible!)

Joyful Noise led by Jenan Gouldsbarry ($0)

Cooking - "Dinner in a Flash" led by Kim McKay ($2)

Card Making led by Serena Trimble ($10)

Retreat Theme Shirt *

Maroon, Long-Sleeve, "Made for More"

S - $20

M - $20

L - $20

XL - $20

XXL - $23

XXXL - $23

No Shirt - $0

Cost *

Please check each box to confirm the associated cost due. A check payable to Chippewa Alliance Church that has "Women's Retreat" in the memo line can be mailed to: Chippewa Alliance Church, 3629 37th St. Ext., Beaver Falls, PA, 15010

Base Registration - $20

AM Elective - Cost listed with selection above.

PM Elective - Cost listed with selection above.

Shirt - Cost listed with selection above.