Winter Peace Retreat at St. Mary of Providence Center
Rewilding the Way
February 10-12,2017 (Friday-Sunday)
Registration Form
Please plan to register early; space is limited. Sometimes we have had to turn away families because of the space limitation. Rooms accommodate two people (two single beds and private bath), and one or two additional family members may be accommodated in the same room on the floor if you wish to bring bedding for them. Single adults who wish to room together should send in their registration forms together, otherwise they will be paired with other singles. (Note: There is an additional $30 charge for a single person who requests a private room.)

Special needs: If you have dietary restrictions or require other special accommodations (e.g., diabetic, or vegetarian, or difficulty climbing stairs, etc.) please include information about your needs. 

Name__________________________________________________________________

Address_______________________________________________________________

City, State____________________________________________ZIP____________

Phone______________________________E-mail_____________________________
[check here ___ if you do not want to be included on the Peace & Justice
Committee's email list.]

Children/Youth:         NAME                      AGE           GENDER

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________


____Adults @ $150.00 each              ___________

____Adult/private room @ $180.00 each  ___________

____College Students   @ $130.00 each  ___________

____Youth  @  $70.00 each              ___________

____Children @ $45.00 each       ___________ 

                  (Additional donation ___________) 
     
                                  TOTAL___________

                        Amount Enclosed___________

                Amount Due at Check-in ___________

Cost to Participants:

$150.00 Adults
$180.00 Single adult in private room
$130.00 College Students
$ 70.00 Youth (rooming with parents)
$ 45.00 Children (Ages 3-10)
Children under 3 are free!

[It is possible for adults to register for only the Saturday program; cost is $60, including lunch and supper. Check with us for additional details.]

Note: We do not take credit card payments because of the additional costs involved. 

Make checks payable to:   Eastern District Conference

Mail this registration form to:
	Carolynn Boyd, Registrar
	1162 Lucy Drive
	Schwenksville, Pa 19473 

Registration deadline is January 20, 2017*
[*Availability of meals & lodging not guaranteed after Jan. 20th - check with Registrar]

Any questions?  Need more information?  
See http://efpjc.ppjr.org/retreat/efp172.htm, or
Call  Carolynn Boyd, 610-489-9084, E-mail: fcboyd@verizon.net