Retreat Registration Form

BETHANY RETREAT CENTER REGISTRATION FORM
Print this page, complete the form and mail it with your payment to:
Bethany Retreat Center, P.O. Box 129, Frenchville PA 16836
Along with a check or money order for the required Deposit amount

Name:
Address:
City/State/Zip:
Phone (home):	(work):
Retreat:
Date:
E-mail:
Special Needs:


Deposit* Amount:
Would you like to be placed on our mailing list? Yes No
Would you like to be placed on our e-mailing list? Yes No

All reservations are subject to confirmation. If registering for more than one person, include name, address, and phone number of each person. Accommodations during scheduled retreats are semi-private or private rooms. *Deposits are Non-Refundable Please make check payable to: Bethany Retreat Center