Retreat Registration – Interdenominational Pastors’ Wives Forum

Note: This form is for people who have not registered or paid. Fields with * are compulsory. Click to register

Full Name *

Email *

Amount (NGN) *

Date Of Birth MM/DD

Church Organisation *

Parish Name and Address *

Personal Contact Address

Select State

Personal Telephone Number(s) *

Profession/Occupation

Name of Employer/Business

Any existing health condition(s) about you that we should know about *

Medication Taken regularly (if any) *

Are you allergic to any food(s)? If yes, please list them out

Other Allergic Reactions *

Activity Restrictions *

Are you on any special diet that we should take cognizance of

Next of Kin

Next of Kin phone number *

Checklist of items to bring

Swimming outfit & accessories insect repellent cream comfortable flats or sneakers sportswear jacket/windbreaker flip flops

* are compulsory
cardlogos

Contact Details