MADWR 2023 Registration – (OTO) 2023 - One-Time 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 Number*Emergency Contact - Name* First Last RelationText 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 - $220.00Maranatha - 3 Ladies - $170.00Maranatha - 4 Ladies - $150.00Maranatha - 5 Ladies - $130.00Friday Dinner? Add $15.00*Yes, I would like Friday DinnerNo, I do not want Friday DinnerYour Total: $0.00 Sign up by 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. Debit Card/Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name CAPTCHA