RPCA Women's Retreat

Number of People Attending *

Names of Those Attending *

Email Address *For form confirmation and email updates about the retreat.

Name *

Relationship *

Phone Number(s) *

Cost: $10 per person

Total Cost *(Add up the costs based on number attending and provide final sum)

*If finances are a difficulty for you or if you would like to make a donation to support someone else please speak to the retreat organizers.

Payment Options *

Cash

Please bring cash to the retreat. We do not have a bank account set up to receive registration fees.

Medical Alerts / Allergies & Reactions (Please give specific details)

Do You Have Ambulance Cover? *

YesNo

Current Medications (if any)

Dietary Requirements (Please give specific details)

Comments

Feel free to send through any comments or questions you may have.