Men of Honor Retreat Offline Registration Form

Men of Honor Retreat

At the Circle of Nations Retreat Lodge
on Spirit Mountain, Eureka Springs, Arkansas
June 24,25 & 26, 2011
Printable OFFLINE REGISTRATION FORM

Name_____________________________________________________
Street Address____________________________________________
State/Province & Zip Code_________________________________

Phone___________________________
E-mail___________________________
Would like to share a room with:____________________________

Diet:
Vegetarian____ Regular____ Special_________

Deposit: $75.00 (non-refundable, required to hold space)
Check____ (Payable to CIRCLE STUDIOS)
Money Order____ (Payable to CIRCLE STUDIOS)
Visa or Mastercard #:_____________________________________
Name:____________________________________Exp:____________
Will arrive:___________________
Need airport pickup_______ (Additional $55.00 one way)
Need directions_______ Send them e-mail____ or snail mail____
Snail mail directions to:_______________________________________
Send the original, fully completed Registration Form to:
The Men of Honor Retreat
c/o Phil Childers
6907 Village Green Blvd.
Pewee Valley, KY 40056