2022 BPC Church Retreat
Please fill out this form and click submit.
Name
*
Who are you registering for?
*
Please select one option.
Individual
Couple
Family
Spouse name?
Name and ages of your children?
Email
*
This address will receive a confirmation email
Phone
*
Address
*
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Do you have any food allergies? If so, please list them.
Which of the following activities would you be interested in? (This is not a final sign-up but an initial survey to gauge interest).
*
Please select all that apply.
High Ropes
Low Ropes
Lake (kayak, canoe, etc...)
Paintball
Arrow tag
Sports Fields
Swimming pool
Do you have a preference for who to room with while there? (Other families, couples, etc...). We can't make promises but this will help in planning.
Payment
Single ($50)
Couple/Family ($100)
Single ($50)
Couple/Family ($100)
Amount
Would you like a t-shirt?
None ($0)
1 ($12)
2 ($24)
3 ($36)
4 ($48)
5 ($60)
6 ($72)
7 ($84)
8 ($96)
None ($0)
1 ($12)
2 ($24)
3 ($36)
4 ($48)
5 ($60)
6 ($72)
7 ($84)
8 ($96)
Amount
What size tshirts (smallest size 2T)?
*
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
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