Fill My Cup, Lord Women’s Retreat

November 1st and 2nd at Four Season’s Resort in Pembine, Wisconsin

Name

First Name

Last Name

Phone

(###)

###

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Food Allergies

Please list any food allergies you may have. If none, please write "none".

Favorite Snack or Candy

Please list your favorite snack or candy.

Roommate Preference

If you have any preference for roommates, please list up to four (4).

Roomate Preference Details

Please list the names of up to four (4) preferred roommates for the weekend. If no preference, please leave blank.

Payment Details

Cost of the retreat is $100. Please select the option to either pay full price, or pay what you can afford and request a sponsorship for the rest.

I can pay full price ($100.00).

I would like a sponsorship.

Payment amount

If you would like to join the retreat and are unable to pay the full $100.00, please list the amount you can afford. If paying the full amount, feel free to leave this field blank.

Important: once you click "submit" you will be automatically redirected to the donation page where you can pay online for the retreat.