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Women's Retreat 2021:

Pray, Heal, Restore

Please fill out all items in it's entirety.

PLEASE BE ADVISED THAT PAYMENT IS NONREFUNDABLE.

First Name

Last Name

Email

Address

Phone Number

Please list any allergies. If none, write N/A.

Any other information, questions, comments or concerns that we should know about, please let us know below. If none, write N/A.

I understand that once I click "Secure My Spot", I will be taken to another page where I will pay my down payment of $215 today in order to secure my provisional spot for the retreat. I also agree that I am able to pay the second half payment of $210 on April 9, 2021, in order to keep my spot. PLEASE BE ADVISED THAT PAYMENT IS NONREFUNDABLE.

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Address:

2557 Buford Drive, Suite 491712

Lawrenceville, GA 30049

Phone:

803-626-2463

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