Retreat Registration

Student Retreat 2021

Register and Pay by October 26, 2021

Step 1: Register

Please fill out the registration information below:

Name *

First

Last

Email *

LOCAL Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Birth Date: mm/dd/yy *

Year in School? *

Emergency Contact *

First

Last

Emegency Contact Phone Number *

Can you drive? *

Yes No

If you can drive, how many can you take, besides yourself? *

Covid Safety Requirement
In accordance with state requirements, masking will be required during the retreat when in the presence of others.
Also out of an abundance of caution, Covid Vaccination or a Negative PCR test results within 48 hour is required to attend.

Please select one of the following: *

I am fully vaccinated. I will provide a Negative PCR test upon my arrival

Dietary Information:

* Indicates required field

Are you a vegetarian? *

Do you have any of the following food allergies: *

Dairy Nuts / Tree Nuts Gluten

* While we will do our best to accommodate you, if you have severe food allergies or intolerance, we suggest that you bring your own food for you to supplement your meals.

Submit

Step 2: Payment

Retreat payment must be made at time of registration.

Click the link below to pay online.

Click to Pay Online

Student Retreat 2021Register and Pay by October 26, 2021​

Step 1: RegisterPlease fill out the registration information below:​

Dietary Information:

Step 2: Payment Retreat payment must be made at time of registration. Click the link below to pay online.

1850 Emerald streeteugene, oregon 97403​541-343-7021﻿(map)﻿

Student Retreat 2021

Register and Pay by October 26, 2021

Step 1: Register

Please fill out the registration information below:

Step 2: Payment

Retreat payment must be made at time of registration.

Click the link below to pay online.

1850 Emerald street
eugene, oregon 97403
541-343-7021
(map)