2024 Becoming a King Retreat – Registration

Personal Information

Name *

Email *

Phone *

Date of birth

Address *

City *

State *

Zip Code *

Retreat Information

How did you hear about this retreat? *

Room Accommodations *

Single Rooms are limited and available on a first come, first served basis.

Roommate Request

Health Information

Do you have any food allergies or dietary restrictions? If so, please describe here:

Shaker Village can accommodate food allergies and dietary restrictions for all meals as long as we know before the event.

Do you have any medical of physical needs that you would like us to be aware of (i.e. CPAP, high blood pressure, physical mobility, etc.)? If so, please describe here:

Name for Emergency Contact

Phone for Emergency Contact

Payment Information

$150 deposit is required with registration or you can choose to pay the full retreat amount.

For this event we can accept payment through Venmo, Cash App, Zelle, or a mailed check. We are not able to accept credit cards at this time.

We are able to refund any/all payments before September 30, 2024 if your plans change and you cannot attend the event.

Payment Amount *

Payment Type *

QR payment codes or address to mail a check will show after your registration is successful

Additional Comments

November 7-10, 2024

Shakertown, KY

$450

Personal Information

Retreat Information

Health Information

Payment Information