Lasting Life Retreat
Application
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Which one applies to you?
I am currently being served by Alive at Last in a shelter, small group or mentorship.
I am currently an active volunteer with Alive at Last.
Neither of the above.
Do you have any roommate preferences?
Please share any dietary needs or allergies.
Do you have any physical limitations?
Do you need transportation to get to the retreat?
Registration Deposit
*
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Lasting Life Retreat -$240/person (50% due now)
50% deposit is due now with the balance being owed upon check in at the retreat.
$
120.00
Payment Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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Submit
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