12th Annual Fall Marriage Retreat (October 13-15, 2023)

Couple Information

Head of Household Name*

First Last

Spouse's Name

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Secondary Phone

Email*

Additional Information

Message/Comments

Please feel free to send any comments or questions along with this registration.

Event Information

Event Options*

Private Cabin ($295) – (9 spots left)
Other Location – Hotel, friends house, etc. ($175)

Billing & Payment

Payment Options*

Register and pay in full
Register and reserve spot ($150 deposit)

Subtotal

Sales & Tourism Tax

Arkansas State Sales and Tourism Tax (10.5%)

TOTAL

Subtotal

Sales & Tourism Tax

Arkansas State Sales and Tourism Tax (10.5%)

TOTAL

Payment Amount

Price: $0.00

Payment Amount

Price: $0.00

Payment Amount

Price:

BALANCE DUE

$0.00

DEPOSIT

$0.00

REMAINING BALANCE

The remaining balance represents the total amount minus your $150.00 deposit. The remaining balance is due in full 3 weeks prior to your event date.

REMAINING BALANCE

The remaining balance represents the total amount minus your $150.00 deposit. The remaining balance is due in full 3 weeks prior to your event date.

Credit Card*

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Acknowledgement*

Yes, I acknowledge I have read the cost and payment terms, cancellation policy, and privacy policy and by submitting this registration I agree to the terms and conditions of use.

A confirmation packet will be emailed within two weeks. Specific instructions for check-in and check-out, what to bring, and directions to camp will be included.

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Registration

Couple Information

Additional Information

Event Information

Billing & Payment