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DISABILITY RETREAT October 17-19, 2025

First Name *

Last Name *

Email *

Phone Number *

Name of Church

Conference Name (if applicable)

Are you a disability leader at your church? *

Yes

No

Do you have a disability? *

Yes

No

Are you a caretaker for someone with a disability? *

Yes

No

Are you vegetarian or vegan? *

How did you hear about the retreat? *

Lodging (Rooms/accommodations are ADA compliant also comes with 6 meals) *

$425/person/single occupancy/1 King Bed

$300/person/double occupancy/ 2 Full Bed (You can be paired with someone)

$300/person/double occupancy/ 2 Full Bed (List Roommate) Total: $600

Donation / Sponsorship

$350

$700

$1,000

$1,500

$2,000

$2,500

$3,500

Roommate's First Name

Roommate's Last Name

Roommate's Email

Roommate's Phone Number

Current Total:

$0.00

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