Emerge 2019


First Name:
Last Name:
Gender:
- choose one -
E-Mail Address:
Phone:
Address 1:
Address 2:
City:
Province:
Postal Code:
Country:
Campus:
- choose one -
Please indicate any food
allergies, or relevant physical
or medical information.
Preferred Room Type:
BUNK (no bedding incl): 4 Per Room - $125 each
Preferred Roommate/Spouse:
Payment Options:
Whole Amount
 

Payment Details
Payment Details: Emerge 2019 Fee
Total : $125.00
Credit Card Number:
Expiry:
December
2018
CVC:
Deposit of $60 is non-refundable
*Balance of registration costs are due at the retreat centre, payable by cash or cheque.
**A late registration fee of $10 will apply after 11:59pm PDT on January 6th, 2019.