MADWR 2023 Registration - (10Mo) - Mid-Atlantic Deaf Women Retreat

MADWR

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 date
ROOMIE(S) PREFERENCE:
MARANATHA RETREAT OPTIONS*
The amount is divided into 10 months. So the amount that you will see in "Your Total" is your monthly recurring (automatic) for 10 months.
- Maranatha - 2 Ladies - $22.00
- Maranatha - 3 Ladies - $17.00
- Maranatha - 4 Ladies - $15.00
- Maranatha - 5 Ladies - $13.00
Friday Dinner? (Add $1.50)*
- Yes, I would like Friday Dinner
- No, I do not want Friday Dinner
Your Total (This will be your recurring 'automatic' payment for 10 months):
$0.00
Sign up by December 15, 2022, so your last payment will be by September 15 (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.
Debit Card/Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
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MADWR 2023 Registration – (10Mo)