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Pastors Renewal Retreat Registration
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Address
*
Your answer
City
*
Your answer
State
*
Choose
GA
FL
NC
SC
TN
VA
WV
Other
Zip Code
*
Your answer
Phone Number (###-###-####)
*
Your answer
Housing Option
*
Multiple Cottage ($135)
Single Cottage ($155)
Dorm Housing ($110)
Off-Site Guests ($75)
Please list any special needs you have with regards to housing.
*
I.e. "ground floor housing," etc. If none, type "none."
Your answer
Your Church
*
Your answer
Church Phone Number
*
Your answer
Church Address
*
Your answer
Church City
*
Your answer
Church State
*
Choose
GA
FL
NC
SC
TN
VA
WV
Other
Church Zip Code
*
Your answer
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