2016 ALLIANCE MEN’S RETREAT – Registration Form LifeWay Ridgecrest Conference Center 800-588-7222; 828-669-9721(FAX) Nov 4 – 6, 2016 PLEASE PRINT OR TYPE Registration Contact ______Phone # ( ) ______

Church Name and Address ______Phone # ( ) ______

______Ø Please list men according to desired room arrangements. Ø Please indicate if charges for group will be paid by REGISTRATION CONTACT ( ) or INDIVIDUALLY ( ). Ø Send $50.00 registration fee for each person (not refundable) by Oct 21st Mail this form to: Ø Cost per person: 2 per room - $165 1 per room - $250 Ridgecrest Conference Ctr 3 per room - $140 Daily – 1 day - $25 P.O. Box 128 4 per room - $130 Daily – 2+ days - $40 Ridgecrest, NC 28770

NAME DEPOSIT PAID ADDRESS (please print legibly) PHONE # ROOM # ______

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DEPOSIT NAME ADDRESS (please print legibly) PHONE # PAID ROOM # ______

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NAME DEPOSIT PAID ADDRESS (please print legibly) PHONE # ROOM # ______

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NAME DEPOSIT PAID ADDRESS (please print legibly) PHONE # ROOM # ______

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