Young Adults Retreat Registration Name* First Last Email* Phone*Transportation*Church Bus/VanDriving on ownDriving with?I have room for more people.*YesNoHow many more can you take?*Emergency ContactsAllergies/Dietary RestrictionsYA Retreat Registration* Price: $105.00 I would like to donate funds towards a scholarship. Please indicate amount. Total $0.00 Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Terms and ConditionsMedia Liability Release: By registering, I am giving Grace Chapel permission to use images, videos, or quotes taken of me/my children in promotional materials, in the newsletter, on the website, or in any capacity for any use in perpetuity.