Newman Retreat Nov 20-22
Newman Retreat
Christ the King Spiritual Life Center
575 Burton Road
Greenwich, NY 12834
518-692-9550
www.CtKcenter.org
Member Information
Fill in All the Information below. You will not be considered signed up unless you have:
1. Paid
2. Filled in your Health Insurance Information.
3. Filled in your Emergency Contact Information
4. Turned in the waiver
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First Name
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Last Name
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Cell Phone
Name of Emergency Contact
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Relationship to you:(mother, father,..etc.) It
can not
be someone on the trip.
*
Emergency Contact Phone Number
*
YOUR
Email Address
*
I agree to abide by the C.W. Post Code of Conduct.
Yes
*
I have the following health issues: (write none if you have none)
*
I have the following allergies
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Health Insurance Company
*
Health Insurance Account Number
*
Download the Domestic Travel waiver
from our website (see recent forms or do a search). Fill it out totally.
Your name
Newman Retreat
November 20-22
I have downloaded the waiver
Payment Options
Your space is not secure unless you have paid. Although you have reserved online, you are not confirmed until there is payment. Spots are only held for 48 hours with out money.
I will pay by:
I will pay cash at the chapel
I will pay online
*
Indicates Response Required