Lifestyle Of Discipleship

When & Where

March 2-4, 2012 (Friday–Sunday)
Taconic Retreat and Conference Center, Milan, NY
Guest Speaker: Dr. Eric Mason

Deadlines & Cost

early registration $85 (1/22-1/29)
regular registration $95 (1/30-2/19)
late registration $110 (2/20-2/26)
married couples with own room $115/person (must register by 2/19)

*Includes $25 non-refundable deposit.
Cancellations must be received no less than 72 hrs in advance in order to refund difference.

First Name: Last Name:

Email:

Date of Birth: YYYY-MM-DD

Phone:

Gender: Male Female

Marital Status: Single Married

Check if you want your own room with your spouse ($115).

Your spouse must also register. Combined cost for a married couple room is $230. Name of Spouse

Current Small Group:

Departure Time: Bus @ 6:00pm Bus @ 7:00pm

Please arrive 30 minutes before your bus departure time.

After 7:00pm

Earliest time you can leave: Note: we will coordinate but additional expenses may be incurred

Driving to the retreat center.

Additional seats available in your car (not including yourself)

Emergency Contact Name:

Emergency Contact Phone:
*Please note your emergency contract should be someone not attending the retreat.

Please list any food allergies and/or medical history/concerns: including but not limited to drug allergies, diabetes, insect-sting allergies, high blood pressure, asthma, physical disability, heart trouble, hemophilia, nervous disability, epilepsy, mental disability.

Consent & Release

I hereby release Remnant Westside Church, its officers, employees, agents, and members of the Board of Elders from all claims and causes of action by reason of any injury which may be sustained as a result of these church activities, whether on the church premises or on the way to or from these activities. I agree to cooperate and conform with directions and instructions of personnel of the organization in charge of these activities. On the account that I do not, I understand that I may be sent home and will be responsible for additional expenses that may incur.

I hereby give my permission to the physician, nurse, or dentist selected by Remnant Westside Church to secure medical or dental aid as required for illness or injury under a physician's orders, including transportation to and from necessary facilities. As a participant, I understand Remnant Westside Church is not obligated to carry any insurance to cover those medical and/or dental expenses. If such insurance is carried, coverage will be provided only for expenses in excess of the limits of the participant's insurance. I understand that my personal insurance is my primary coverage.

This authorization shall remain effective until revoked in writing delivered to Remnant Westside Church.

Departure

please arrive at the New York Society of Ethical Culture 30 minutes PRIOR to your departure time.
please grab dinner beforehand.
if you cannot take any of these buses, we will help coordinate separate transportation. however, you will have to pay for any additional expenses incurred in the process.

Things to Bring

bible
pen & paper
sleeping bag
sunday offering
towel, toiletries & other personal items

General Information

When & Where

Deadlines & Cost

Registration Form

Consent & Release

Additional Details

Departure

Things to Bring