1. Application for 2012 Retreats
2. Location Please Select A Location January 18 – 22: Yorktown, TX February 2 – 5: Arlington, TN February 16 - 19: Jacksonville, FL March 2 – 5: Arlington, TN March 15 – 18: CrossHeirs Retreat Center, Sherwood, AR April 10 – 13: Branson, MO April 16 – 19: Branson, MO May 14 – 18: Pigeon Forge, TN June 5 – 8: Scottsdale, AR June TBA: Toledo Bend, LA July TBA: Memphis, TN August 7 – 10: Branson, MO August 13 – 16: Branson, MO August 31 – September 3: Memphis, TN September 17 – 21: Centennial, WY October 2 – 6: Challis, ID October TBA: TBA November 1 – 5: Warrensburg, NY November 8 – 11: Warrensburg, NY *
3. Full Name*
4. Preferred Name

Contact

1. E-mail*
2. Work Telephone*
3. Home Phone*
4. Cell Phone
5. Street Address*
6. City, State, Zip*

Spouse

1. Spouse's Preferred Name
2. Spouse's Work Telephone:

Ministry Info

1. Church or ministry name*
2. Location of church or ministry
3. What is your current position in the church?

About

1. What is your age group? Please Select One 20s 30s 40s 50s 60s 70s or older
2. What is your personal goal for attending the retreat?*
3. What do you perceive to be your greatest needs at this time?*
4. What are your wife's greatest needs?*
5. What do you believe to be the greatest problems you face in your ministry?*
6. Are you able to climb stairs? Yes No

 

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