Pastors’ Wives Winter Social Registration

If planning to attend the Pastors' Wives' Winter Social, please complete this form.

"*" indicates required fields

Name*

First Last

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Emergency Contact*

First Last

Emergency Contact Phone*

Lodging

Please expect double to triple occupancy per room. Groups of 4 or 5 can also be accommodated upon request. You may enter your roommate requests below.

Roommate Request #1

Roommate Request #2

Roommate Request #3

Dietary Restrictions

Please list any food allergies or dietary restrictions.

Additional Accommodations, Questions, or Requests

Please list any additional accommodations, questions, or requests or you may have. You may also contact the Camp office at 319-848-4187 or programdirector@iodiseca.org

Retreat Fee*

Price:

You'll receive a confirmation email to verify your registration and to provide information on how to make a payment.