MADWR 2023 Registration - (CZ) - Mid-Atlantic Deaf Women Retreat

Name*

First Last

Address*

Street Address City State ZIP Code

Email*

Text Number*

Emergency Contact - Name*

First Last

Relation

Text Number*

Special Accommodation

Need Accessibility
Need Deaf-Blind Interpreter
Special Diet - an online form will be emailed to you 2-3 weeks before retreat

ROOMIE(S) PREFERENCE:

MARANATHA RETREAT OPTIONS*

Maranatha - 2 Ladies - $220.00
Maranatha - 3 Ladies - $170.00
Maranatha - 4 Ladies - $150.00
Maranatha - 5 Ladies - $130.00

Friday Dinner? Add $15.00*

Yes, I would like Friday Dinner
No, I do not want Friday Dinner

I would like to pay with:*

CHECK (mail to Marilyn Skidmore)
ZELLE (madwrinfo@gmail.com)

CHECK is to be mailed to Marilyn Skidmore, 320 Madison Rd, Willow Grove, PA 19090. ZELLE payment payable to MADWR madwrinfo@gmail.com

Pick your amount:*

The total amount is to be paid by August 31, 2023.

Paying IN FULL amount today
Paying partial amount today

If paying partial amount today, how much will you pay?

Your Total:

$0.00

Full balance is due August 31 , 2023, (for FULL refund - let us know by August 31, 2023). --- If you do not receive an email confirmation, please email madwrinfo@gmail to follow up on your registration and payment.

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MADWR 2023 Registration – (CZ)

2023 - CHECK or ZELLE