REGISTRATION FORM

RETREAT NAME:____________________________________________________________________ 

DATE:_____________________________________________________________________

DEPOSIT:__________________________________________________________________


NAME: ___________________________________________________________________

NUMBER OF PERSONS: ______________ MALE/FEMALE: _______________

ADDRESS: ________________________________________________________________ 

CITY: ________________________ STATE: ____________ ZIPCODE: _______________

HOME PHONE:______________________________

CELL PHONE:_______________________________

E-MAIL:____________________________________________________________

Comments: (be sure to include any special needs): ________________________________________________________________________

__________________________________________________________________________

Registration for Scheduled Retreats cannot be reserved until we receive this 
registration form and a $100 deposit per person.  

Make checks payable to, "Little Portion Retreat & Training Center".

Mail payment and registration form to:

Little Portion Retreat & Training Center
Attn: Peggy Lodewkys, BSCD
171 Hummingbird Lane
Eureka Springs, AR 72632

or call to use your credit card for your deposit (479) 253-7379

You may also make your reservation at our online store:
http://bsc.weship4you.com/scripts/prodList.asp?idCategory=9