Please Circle
which program you are attending:
Retreat I - April 18-19
Retreat II - April 19-20
If you are
interested in attending an extended retreat, please circle
both Retreats I & II - cost $130
Name_____________________________________________________________________________
Address___________________________________________________________________________
City______________________________________________________ Zip______________________
Phone(s):___________________________________________________________________________
email:______________________________________________________________________________
Home Church:_______________________________________City______________________________
First time at Lake Aurora? ________
Cost
: $65 if staying on campus, $60 if staying off
campus (Part time guests: $30 for Friday only, $35
for Saturday only)
Please add a 3%
surcharge when using a corporate account credit card.
Mastercard Visa Amount to be charged: _________
CC
#____________________________________________________________exp_______________
Last 3 digits located on back of card________________
Authorized Signature:_________________________________________________________________
Name on
card:_______________________________________________________________________
Billing address of
cardholder:___________________________________________________________
City:___________________________________ST:___________Zip:________________________
Phone of card holder:
______________________________________________________________
HOUSING - 290 beds
are available for this retreat. Housing assigned by camp
office. If requesting an entire group
to be housed together,
please send in together. Please state if your lodging will
not be on campus.
Please CIRCLE - I will be staying in: Dorm/Cabin Motel Other____________
_____I am physically
UNABLE to sleep on a top bunk.
_____I have a diabetic need for my desserts.
Submit this form and
money to the camp office. Fax 863.696.1062
(Credit card payments)
A Confirmation
ticket will be mailed to you if received five days prior to
retreat date.