Name (First and Last):  

Name you go by (Nickname):

Address:  

City: State: Zip:  

Cell Phone: Other Phone:  

Sex:     (For dorm assignment purposes)

Email:  

Registration fee: Includes 5 meals and 2 nights lodging (lodging is dormitory style at the Apison Retreat Center)*

$45.00 until May 1, $55.00 May 2 to June 1, and $65.00 after June 1).

Community you represent:

If you hold a position on your Council, what is it?

Are you a Spiritual Director on your weekends? 

T-Shirt size (S, M, L, XL, 2X, 3X):

Do you have any special diet needs that we should be aware of?

If you are flying in, will you need bedding to be provided? 

If you are flying to Chattanooga, will you need transportation assistance to/from the airport? 

If you are flying in to a different airport, will you need transportation assistance to/from the Groome Transportation center in Chattanooga? 

Will you be staying at the Retreat Center?   (Yes or No)   

If you are staying at the Mainstay Suites, will you need transportation to/from the hotel and retreat center? (Yes or No) 

Which of the following topics are you most interested in?  (Check all that apply)

        Essentials Training
        Community Updates (including successes and challenges for 2018 action items 
        Team Commitment and Involvement 
        Enhancing Team Training
        Staying Connected After the Weekend
        Legal Issues and Requirements (Background checks, Mandatory Reporting, etc) 
        Youth Leadership on Weekends and Councils 
        Spiritual Director Outline Review 
        Fundraising Opportunities 
        Online applications and payment
        Other   Please specify
 

 Payment options will be presented after you submit this form.

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