Beloved: In-House Women's Retreat
Please fill out this form and click submit.
Beloved:
In-House Women's Retreat
Location: Sparta Church
Friday, April 28th | 7pm
Saturday, April 29th | 9am-3pm
Breakfast and Lunch will be included
.
Cost
Before January 31st | $45
After January 31st | $60
Pay it Forward Option
$90 | Buys your tick
et & adds a ticket to our scholarship fund.
Name
*
Email
*
This address will receive a confirmation email
Phone
*
Payment
Before Jan 31st ($45)
Pay it Forward ($90)
Before Jan 31st ($45)
Pay it Forward ($90)
Amount
Are you choosing to pay a ticket forward?
*
Please select one option.
Yes, I will choose the scholarship recipient.
Yes, please have the church choose the scholarship recipient.
No, I am not paying a ticket forward.
Please provide the name of the scholarship recipient you would like to give a ticket to. (write n/a if it does not apply to you.)
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
Description
Please fill out this form and click submit.
×
Please Fix the Following
