Encounter Retreat (2024)

Genesis Christian Church Encounter 2024 Registration Form

We are thrilled that you are interested in joining us for this life-changing event. Please take a few moments to complete the registration form below. Your responses will help us ensure that your experience is as enriching and comfortable as possible.

Important Information:

• Dates: October 25 – 27, 2024

• Location: Genesis Christian Church, 1490 Banks Road, Margate, FL 33063

• Registration Fee:

• Early Bird Payment: $80.00 (Deadline: August 15, 2024)

• Regular Payment: $100.00 (After August 15, 2024)

• Final Deadline for All Registrations and Payments: September 30, 2024

• A Genesis Christian Church minister will reach out to you directly to confirm your registration and provide additional details about the retreat.

Section 1 of 8: Basic Contact Information

Please select today's date *

First Name: *

Last Name: *

Email (if no email, enter [email protected]) *

Phone Number *

What is your Gender: *

—Please choose an option—MaleFemale

What is your Age Range? *

—Please choose an option—18–2425–3435–4445–5455–6465–Over

Street Address *

Address (Line 2)

City *

State *

—Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code *

Section 2 of 8: Marital Information

Marital Status: *

—Please choose an option—SingleMarriedDivorcedWidowWidower

Section 4 of 8: Dietary Information

Dietary Preference: *

—Please choose an option—VegetarianChickenFish

Do you have any medical conditions and/or allergies we should be concerned about? (If none, enter 'N/A') *

Do you have children? *

—Please choose an option—YesNo

Is any family member(s) attending this Encounter with you? *

—Please choose an option—YesNo

Section 6 of 8: Emergency Contacts

Please Provide Contact Information for at least four (4) Emergency Contacts:

Emergency Contact #1 Name: *

Emergency Contact #1 Relationship (i.e. brother, sister, niece, etc...): *

Emergency Contact #1 Email Address: (if no email, enter [email protected]) *

Emergency Contact #1 Phone Number: *

Emergency Contact #2 Name: *

Emergency Contact #2 Relationship (i.e. brother, sister, niece, etc...): *

Emergency Contact #2 Email Address: (if no email, enter [email protected]) *

Emergency Contact #2 Phone Number: *

Emergency Contact #3 Name: *

Emergency Contact #3 Relationship (i.e. brother, sister, niece, etc...): *

Emergency Contact #3 Email Address: (if no email, enter [email protected]) *

Emergency Contact #3 Phone Number: *

Emergency Contact #4 Name: *

Emergency Contact #4 Relationship (i.e. brother, sister, niece, etc...): *

Emergency Contact #4 Email Address: (if no email, enter [email protected]) *

Emergency Contact #4 Phone Number: *

Section 7 of 8: Final Comments

Please Provide Any Additional Information or Comments