Retreat Registration Form

Come Away with Me :: an extensive care retreat

Each person registering for a retreat must submit a completed registration form and pay a $250 non-refundable deposit. A reservation for a retreat is not guaranteed until the form and deposit is received. The remaining balance ($1,545) must be paid in full 45 days prior to the beginning of
the retreat.

Please download & print the Payment Form.

You can also download a copy of this Registration Form to print, complete, and return it to:

Healing Care Ministries
PO Box 772
Ashland, OH 44805

First Name:*

Last Name:*

Email:*

Age:*

Sex:*

Address:*

City:*

State/Prov:*

Zip/Post Code:*

Country:

Home Phone:

Work Phone:

Cell Phone:

Are you or your spouse a participant (or have been a participant) in the Pastors of Excellence program at Ashland Theological Seminary.*

Please reserve my place at the following retreat:*

April	June	August	October

NOTE: All accommodations are shared, double occupancy. A limited number of single rooms are available on a first-come, first served basis for an additional charge of $350.

Yes, I'm interested in a single room if available.

Please list any special dietary requirements for meals, allergies, handicap needs or health issues:

The book, Draw Close to the Fire by Terry Wardle is required reading for the retreat. A few weeks before the retreat, you will receive a pre-retreat journal, which corresponds with this book.*

I have a copy of Draw Close to the Fire
I do NOT have a copy of Draw Close to the Fire

A $250 non-refundable deposit is due at registration to reserve your place at the above retreat. Indicate your intention below:*

I am mailing a check payable to "Healing Care Ministries" to PO Box 772, Ashland, OH 44805
I will call in my credit card information to the Healing Care office at 419-612-7785.
Other (please specify)

By submitting this registration form, I agree to the above arrangement to pay my $250 deposit to complete the reservation at the noted retreat. I will be notified via email when my reservation is received in full. By including my name and date below, I understand my $250 deposit is non-refundable. I also understand that the balance of the retreat ($1,545) is due 45 days prior to the retreat and if the balance is not paid by this deadline, my reservation can be canceled automatically.*

Date:*

	MM	DD	YYYY
	/	/

Enter the text you see in the security image (not case sensitive):

Upcoming Events June 6-9, 2012
Formational Prayer Seminar June 18-25, 2012
Extensive Care Retreat July 18-21, 2012
Formational Prayer Seminar: Colorado Springs September 5-8, 2012
Formational Prayer Seminar, ADVANCED October 1-8, 2012
Extensive Care Retreat