MADWR 2023 Registration - (OTO) - 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
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
Your 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 Express
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Card Number Expiration Date Security Code Cardholder Name
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MADWR 2023 Registration – (OTO)