Registration Form

The Annual Christian Women's Retreat

Registration Form

COMPLETE THE ELECTRONIC FORM ONLY IF YOU ARE USING OUR ONLINE PAYMENT PROCESS; OTHERWISE, TO SUBMIT YOUR PAYMENT BY MAIL, CLICK ON THE LINK BELOW TO DOWNLOAD THE REGISTRATION FORM.

Download 2010 Registration Form

Full Name
Home Address
Phone Number
Email Address
City
State/Zip
Church Name
Church Address
ACWR Member (paid fee each year)
Adult-Youth
Meal Package (includes Banquet and Sunday only)
Free T Shirt
*T-shirts and additional ACWR items for purchase - (payment for these items must be submitted by mail)
Please_indicate_any_special_dietary_needs
Total_Payment_ Amount

Please Note:

If you have not paid for your registration and meals by the deadlines, please include the appropriate late fees.

Online registration includes completing the electronic registration form and submitting your payment using a debit or credit card.

Once you submit your form, please go to the link pay online to submit your payment electronically.

*Please send payment for mail in registrations or additional items for purchase to:

ACWR

1505 Edgewood

Elizabeth City, NC 27909

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