2018 ECW/DOK Annual Meeting and Retreat
April 27-28, 2018 | Please fill out this form to register for the retreat and click submit.
Members who register and pay in full by March 31 will be entered into a drawing for a prize with a $200 retail value!
Registrant Information
Name
*
Email
*
This address will receive a confirmation email
Phone
*
Address
*
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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
Church
*
Payment Information
Primary Registrant
Both Friday and Saturday ($65.00)
Friday Reception and Banquet Only ($40.00)
Saturday Only ($25.00)
Both Friday and Saturday ($65.00)
Friday Reception and Banquet Only ($40.00)
Saturday Only ($25.00)
Amount
Guest
No Guest ($0)
Both Friday and Saturday ($65.00)
Friday Reception and Banquet Only ($40.00)
Saturday Only ($25.00)
No Guest ($0)
Both Friday and Saturday ($65.00)
Friday Reception and Banquet Only ($40.00)
Saturday Only ($25.00)
Amount
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
April 27-28, 2018
Please fill out this form to register for the retreat and click submit.
Members who register and pay in full by March 31 will be entered into a drawing for a prize with a $200 retail value!
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