Attendee Information

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Please provide a VALID email address. ALL retreat information will
be communicated to the email address provided.

Emergency Contact

*Cannot be someone registered to attend this retreat.

First Name *

Last Name *

Relationship to You *

Phone Number *

Second Emergency Contact (optional)

First Name

Last Name

Relationship to You

Phone Number

Transportation To/From Retreat

What City and State are you coming from? *

How are you getting to the retreat? *

See aiport and travel information below.

If driving alone, are you willing to carpool with others who may be attending from same city/state?

Food Allergies

Do you have any food allergies? *

If you have a food allergy, please list here.

*We cannot provide a specialized menu to accomodate alternative eating lifestyles or diets. However, we will try to ensure the menu has varying options.

Sample Menu

Breakfast

- Scrambled eggs, sausage, biscuits & gravy
- Pancakes, hot syrup, bacon, yogurt

Lunch

- Grilled hamburgers, potato wedges, chocolate chip cookies

- Chicken sandwiches, macaroni & cheese, cookies

Dinner

- Homemade lasagna, corn, brownies & ice cream sundaes

- Barbecued chicken, baked potatoes, green beans, banana pudding

**Dinner includes salad, rolls, iced tea, punch, water

A refrigerator will be available if you need to bring items that require refrigeration.

Lodging and Amenities

All attendees will be sleeping on bunk beds and will be sharing a room with 2-4 other women.

Everone will NOT be able to secure a bottom bunk. We will do our best to accomodate requests for bottom bunks due to specialized needs such as: medical situations, age, etc.

Please indicate below if you need a bottom bunk.

*Beds are reserved on a first come basis.

I am requesting a bottom bunk for medical or other specific reasons.

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Bed Linens and Towels

Pillows, fitted and regular sheets, a towel and a washcloth are provided for each attendee.
However, we suggest you bring additional towels if you want to have extras.

Additional Items to Bring

**We suggest you bring the following items:

- Hair dryer

- Hair products

- Hygiene products (to include toothpaste/toothbrush)

- Suntan lotion

- Swimsuit (beach and pool available to attendees)

Retreat T-Shirts

All attendees will receive a complimentary t-shirt

Select your t-shirt size *

Special Hobbies, Skills, or Expertise?

Do you specialize in any of the following? Teach classes/workshops? Coach?

*

If you selected "Other" please explain below.

Images/Videos

All images and videos captured during the retreat are the property of Ann-Maria Benton Ministry and can/may be used for promotional/marketing purposes. Our ministry will NOT use pictures/videos in conjunction with names when sharing via social media or other resources.

If you record a video testimony during the retreat, only your fist name will be displayed. Videos may be edited for reasons such as: length, lighting, speed, etc. Videos will NOT be altered to change the likeness or appearance of the invidual recorded.

Airport Information

The retreat location is in Panama City Beach, Florida (Exact location will be provided 2 weeks prior to retreat start date).

If flying, you have two options:

- Northwest Florida Beaches Intl (ECP). It's about 31 minutes (17 miles) from Retreat Location.

- Destin Fort Walton beach-Destin (VPS). It's about 1 hour (50 miles) from the Retreat Location.

You are responsible for transportation (taxi, Uber, or Lyft) to the retreat on Thursday and back to the airport on Sunday morning.

Estimated Uber costs:

- From ECP airport approximately $40

- From VPS airport approximately $100

* Estimates provided by Uber Estimator

Retreat Arrival / Departure Information

Retreat Dates

Arrival
Thursday, September 21: Check in Time: Beween 2 - 6 pm CST (Central Standard Time)

Departure
Sunday, September 24: 9:30 am CST (Central Standard Time)
** Please keep in mind that Central Standard Time is one hour behind Eastern Standard Time. Example: If it's 4pm ET, it's 3pm CST).

Please book your flights or plan your drive time to align with these times.

Dinner will be served at 6pm (CST) on Thursday evening and Welcome/worship begins at 7:30pm CST. *Please do all you can to be in place BEFORE dinner begins at 6pm CST.

Payment and Refund Information

The entire retreat is $375 per person.

$75 deposit is required to reserve your spot.

After deposit is paid, the balance of $300 will be paid monthly (due by the 20th) of each month for 5 months). Entire payment due MUST be received before August 31, 2023.

Please read refund policy carefully

- If attendee cancels reservation, $75 deposit is NON-refundable.

- If attendee cancels after making payments, deposit is non-refundable. We will determine the amount of

payment to be refunded on an individual basis.

- If retreat has to be canceled due to unforseen circumstances (COVID outbreak, inclement weather, etc.),

retreat host will communicate the outcome (full refunds or reschedule).

*

I have read the payment and refund information and I agree to the terms outlined.

Please Add Your Signature *

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Make your selection today. Information for on-going payment plan will be emailed to you once you've reserved your spot. *

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***If you plan on using Paypal, please make sure your phone number is correct in your paypal account.

***Complete the payment process all the way through until you receive a successfully completed message.

You will receive a confirmation email within 48 hours.