MADWR 2022 One-Time Pay Online MADWR 2022 Registration - One-Time Payment ONLINE MADWR Name* First Last Address* Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email* Text or Videophone NumberText NumberVideophone NumberEnter Your Text or Videophone Number here:*Emergency Contact - Name* First Last RelationText Number*Special Accommodation Need Accessibility Need Deaf-Blind Interpreter Special Diet (describe below) Special Diet (include what you cannot eat)ROOMIE(S) PREFERENCE:Which Retreat Plan would you like to pick?*[Select One]MaranathaWPWMEALS ONLYMARANATHA RETREAT OPTIONS*Maranatha - 2 Ladies - $205.00Maranatha - 3 Ladies - $155.00Maranatha - 4 Ladies - $135.00Maranatha - 5 Ladies - $115.00WPW RETREAT OPTIONS*WPW Lodge - 2 Ladies - $215.00WPW Lodge - 3 Ladies - $165.00WPW Lodge - 4 Ladies - $145.00WPW Lodge - 5 Ladies - $125.00MEALS ONLY OPTIONS*Weekend 5 Meals (Sat. Br. - Sun. Lunch) - $75.00Weekend 6 Meals (Fri. Dinner. - Sun. Lunch) - $90.00Saturday 3 Meals (Sat. Br - Sat. Dinner) - $60.00Friday Dinner? Add $15.00*Yes, I would like Friday DinnerNo, I do not want Friday DinnerWould you like a black shirt with embroidered MADWR Logo?*This is OPTIONAL - You can pick POLO long sleeve or T-SHIRT short sleeve Let us know by August 1, 2022Yes, I would like a POLO long sleeve $25Yes, I would like a T-SHIRT short sleeve $15No, I do not want a shirtPick your size:[Pick your size]SMLXL2XL3XLYour Total: $0.00 Sign up by September 1, 2022, (for FULL refund - let us know by September 1, 2022). --- 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 ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name CAPTCHA