2019 JRR Beach Retreat

2019 Retreat Application

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Marital Status *

Name of Spouse/Roommate *

First

Last

Room Preference *

King Double 1 BDR Suite (Additional $11)

Room Deposits Due By October 24th *

Retreat Fees Due By October 24th *

Youth Retreat Fees Due By October 24th *

Total Registration Fees (Includes T-Shirt) *

Adult Registration Fee after October 24th: $50.00 — Youth Registration Fee after October 24th: $20.00

Denim & Diamonds Banquet Adult: $40.00

Denim & Diamonds Banquet Children: $20.00

Adults *

Children (5 & Under, No Charge) *

Total Banquet Fees *

Total Fees Due

Please Include total for: 1st Night’s Deposit, Registration, and Banquet Fees for all Registrants including Youth *

Make Checks Payable to: COGOP
**Contact us if you would like to wirelessly transfer your Registration Fees.**

Adult T-Shirt Size *

Youth T-Shirt Size *

List T-Shirt Sizes for more than 2 Children Below: *

Contact the SpringHill Suites at 757.417.3982, if you would like to pay your ROOM DEPOSIT ONLY by credit card. Inform the clerk that you are with the Church of God of Prophecy.
*If you are paying your room deposit by credit card: your registration, banquet, and Youth Retreat fees must be mailed or sent via electronic money transfer, e.g. Zelle, CashApp*

If you are mailing your application and fees, please forward to: Mrs. JoAnne Ricks, 5363 Grey Oaks Road, Trinity, NC 27370.
Email: jricks@northstate.net
Phone: 336.431.5132

Submit

Early Registration Now - October 24th

2019 Retreat Application

Total Fees Due