Elim Retreats
Come unto me... and I will give you rest.

Retreat Registration

 
Selected Retreat Location: Huron City, Michigan
Selected Retreat Week: Jun 24 - 29
 
Marital Status:  
Your Name:
*Only fill in Spouse Name if your spouse is attending the retreat.
Spouse's Name:
Your Ages:
Child 1 Name:   Child 1 Age:
Child 2 Name:   Child 2 Age:
Child 3 Name:   Child 3 Age:
Email Address:
Best Time to Reach:

- Billing Address -
This must be the address where the credit card billing is sent

Stateside Phone:
Stateside Address:
Stateside Zipcode:
 
Overseas Phone:
Overseas Address:
 
Location in Which You Serve:
Capacity in Which You Serve:
Agency/Church:
Agency/Church Address:
Agency/Church Phone:
Agency/Church Team Leader:
Agency/Church Contact Person:
 
Special Requirements:
 
How Did You Hear Abou ELIM?:

Payment Type:  
Total Payment: $0.00
We Accept:
Credit Card Number:
Card Verification Value: 3-digit code on back of card.
Expiration Date:  
Make Checks Out To "Barnabas International" And Send To:

Barnabas International
PO Box 11211
Rockford IL 61126-1211