Registration  (Retreat size limited to 20)

If registering for someone in addition to you please copy this form and fill out one for each of you.

Name of Event:______________________________________________________________________

Name (Last)__________________________________(First)__________________________________

Name as I would like it to appear on my name tag___________________________________________

Address___________________________________State______________Zip______________

Phone (W)________________(H)_________________(Cell)_____________(email)_______________

I would like to room with __________________________________________________________

Special eating and/or physical needs? Please let us know at this time___________________________                                                                

My deposit of $350 is enclosed ____   final payment of $_______________due upon arrival

Visa/MasterCard #________________________________Exp. ________Code_____ or Check #_________

Currently, this is not a secure website.  Please mail in your registration with a check or credit card or you may call us with your credit card number.

For more information please email: info@stillpointlodge.com or call 907-296-2283