Grief Retreat 2026 Registration

Registration Form

Fields marked with are required.

Section 1 — Participant Information

First Name

Last Name

Date of Birth

Address

City

State

ZIP

Phone

Home Church

Conference(optional)

Section 2 — Emergency Contact

Name

Relationship

Phone

Alternate Phone(optional)

Section 3 — Registration — All-Inclusive Package

Registration includes hotel accommodations (2 nights), all meals, and retreat materials.

Select your package

Double Occupancy — $250.00 per person (all-inclusive)Single Occupancy — $390.00 per person (all-inclusive)

Preferred Roommate (if any)(optional)

Section 4 — Payment Method

Payment method

CheckPayable to: South Atlantic Conference — memo: Grief Retreat 2026Money OrderOnline / Other

Amount Enclosed(optional)

Payment Date(optional)

Section 5 — Special Needs & Dietary Requests

VegetarianVegan

Food Allergies (optional)

Mobility / Accessibility Needs (optional)

Section 6 — Optional — In Loving Memory

If you wish, share the name of the loved one(s) you are honoring this weekend. This information is confidential and used for ministry purposes only.

Name(s)(optional)

Relationship(optional)

Section 7 — Consent & Signature

I consent to participate in retreat activities and authorize the use of event photographs for ministry publications unless I notify the organizers in writing.

I agree to the consent statement above.

Signature

Type your full legal name as your electronic signature.

Date