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Pastor and Spouse Retreat Registration Form

Thank you for your interest in one of our upcoming Pastor and Spouse Retreats. This will be a special time away and an opportunity for enrichment designed just for pastors and their spouses.

If you have any questions about this event, please feel free to call our Pastoral Ministries department toll-free at (866) 542-1212 during office hours (Monday through Friday, 8:00 AM - 5:00 PM, Mountain time).

If you or your congregation would like to sponsor your pastor and his wife at an event, we offer you a gift certificate that can be presented to your pastor and spouse when this gift is announced. (This PDF file will require Adobe Reader.)

To sign up for a retreat, please complete the following information. Lines with asterisks ** indicate information that is required to register. Other optional information will help us to better serve the personal needs of your pastoral family.

Event Information

Event: **

Sponsor Information

I am a sponsor.

Title:
First Name:**
Last Name:**
Address 1:**
Address 2:
City:**
U.S. / Canadian State:**
Non-U.S. Region:
Zip:**
Country:
Phone:**	xxx-xxx-xxxx
Fax:	xxx-xxx-xxxx
E-mail:**
Confirm E-mail:**

Attendee Information

Pastor's Title:

Pastor's First Name:**

Pastor's Last Name:**

Spouse's Title:

Spouse's First Name:**

Spouse's Last Name:**

Address 1:**

Address 2:

City:**

U.S. / Canadian State:**

Non-U.S. Region:

Zip:**

Country:

Phone:**

xxx-xxx-xxxx

Fax:

xxx-xxx-xxxx

E-mail:**

Confirm E-mail:**

Pastor's Cell Phone:

xxx-xxx-xxxx

Pastor's Gender:

Pastor's Ethnicity:

(Check all
that apply)

African-American
Asian
Caucasian
Hispanic
Native-American
Other

Church Position: **

Spouse's Cell Phone:

xxx-xxx-xxxx

Spouse's Gender:

Spouse's Ethnicity:

(Check all
that apply)

African-American
Asian
Caucasian
Hispanic
Native-American
Other

Special Needs: (diet, allergies, physical limitations, etc.)

Other Considerations:

Church/Organization Information

Name: **

Address 1: **

Address 2:

City: **

U.S. / Canadian State: **

Non-U.S. Region:

Zip: **

Country:

Phone: **

xxx-xxx-xxxx

Fax:

xxx-xxx-xxxx

E-mail:

Confirm E-mail:

Web Address:

Worship Attendance:

Ethnic Nature
of Congregation:

(Check all
that apply)

African-American
Asian
Caucasian
Hispanic
Native-American
Other

Denomination:

Method of Payment

Registration Payment By: **

I will call (866) 542-1212 to arrange payment.

I understand that this registration will not be completed until Focus on the Family has received full payment.

Form Status

This form has not yet been submitted.
A confirmation message will be sent to you upon the successful submission of this form.

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