Event 2 RSVP - National Association of Evangelicals | National Association of Evangelicals

BIPOC Spiritual Retreat Registration

"*" indicates required fields

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Phone*

Job Title/Role*

Church/Organization*

Denominational/Institutional Affiliation*

Invited By:*

Dietary Restrictions*

Please choose your rooming cost:*

$260: Double room

$340: Single room

$190: Commuter (No lodging)

Double room

Price:

Single Room

Price:

Commuter

Price:

Would you like to make an additional donation to sponsor someone?

Yes

Quantity

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Discount Code

Total

Is there someone you would like to share a room with?*

Why did you decide to register for the BIPOC Spiritual Retreat?*

What do you hope to gain from your time at the retreat?*

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Phone

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