Shiloh Baptist Church
Darlene Hill, Mission President
Walstone E. Francis, Pastor
Christian Women’s Retreat Registration Form
Wyndham Garden
Wyndham Garden Hotel Buffalo Grove, IL
October 20-21, 2006
If you wish to register more than one person, please feel free to copy this form. Mail registration form and check to Shiloh Baptist Church 800 South Genesee Street, Waukegan, Il 60085. Please call the church office at 847/662-6325 or Pat Appling for further information.
1. Yes, please register me for the Shiloh Baptist Church Women’s Retreat. This registration
Includes 1 night single accommodation. Single Room $147.00*. Cost $________
2. Yes, please register me for the Shiloh Baptist Church Women’s Retreat. This registration
includes 1 night accommodation sharing a room with the following people ___________________________________, _______________________________,
_______________________________ Sharing cost for two people $110.00* per person,
three people $100.00* per person, four people per person $95.00*. Cost $________
* Cost include (1) Lodging (2) Friday night banquet (3) Saturday lunch
3. I require a handicapped room: Yes___ No ___ I require transportation: Yes___ No ___
|
$ |
|
|
Total fees due
Method of Payment __________Cash ________ Check ______Money Order
Cancellation: Reservations canceled after fee has been paid are subject to cancellation penalties unless a replacement can be found. NO REFUNDS CAN BE MADE AFTER OCTOBER 5, 2006.
I have read and accepted the cancellation refund clause as listed above.
----------------------------------------------------------------------------------------------------------------
Registrant Information:
|
Name: |
|
Address: |
|
City: |
|
Daytime Phone: Cell Phone Number: |
|
Emergency Contact/Phone Number: T-Shirt Size S ____ M____ L____ XL ____XXL ____ ______________________________________________________________________________ |
Signature :________________________________________( Date: ______________________________