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*

Would you like to share a room (no charge) or stay in a single occupancy room ($194 charge)?*

Share a room (FREE)

Stay in single occupancy room ($194 charge)

Single Room

Price:

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

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?*

Name

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