Women's Retreat 2012 | Unity Church of Overland Park

Early registration fee by February 19 - $170
Registration fee until March 20 - $180

NOTE: This form uses PayPal to process payments, however, you don't need to create a PayPal account in order to use a credit card for payment.

First Name	Last Name
Address	Email Address
City	State	Zip
Phone (Day)	Phone (Cell)
Preferred Roommate (if any) All women will be assigned roommates	Emergency Contact & Phone
I would like to make a donation to the Scholarship Fund in order to help someone else attend this retreat, in the amount of:	I want to support the retreat. Contact me about volunteer opportunities! Yes No
Please ensure all information is filled out correctly before proceeding. Registration completed at PayPal. Cancellation policy: Cancel before February 19 for a full refund, cancel after February 19 and before March 27 for a full refund, less $25 processing fee, no refund after March 27.