2023 Ecclesia Regional Gathering: Mid South

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

March 21 & 22, 2023- Blacksburg, Virginia

First Name *

Last Name *

Email *

Church Name

Are you a member of an Ecclesia Network Church?

Yes

Clear selection

Allergies/Health Concerns

Housing

I would like more information about staying in a local leader's home

I plan to stay in a hotel or have made other housing arrangements already

Clear selection

If you would like to stay in the home of a local leader, please indicate if you will be arriving on Monday evening and/or staying Wednesday Evening.

Optional Pre-Gathering Lunch

For those in town, we will be heading to Cabo Fish Taco for lunch on Tuesday before the gathering starts. Please let us know if you will be arriving before noon. (this lunch is not included in the cost of the gathering).

Yes- I plan on attending!

Clear selection

Tuesday Dinner Menu Selection

Dinner Tuesday is at Lefty's Main Street Grille (a local spot in town). Please review their dinner menu and place your order in the box below. Please also include any necessary changes to accommodate food needs. (This meal is covered in the cost of the event.)

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of New Life Christian Fellowship. Report Abuse

Forms