Then Jesus approached and said to them, "All power in heaven and on earth has been given to me. Go, therefore, and make disciples of all nations, baptizing them in the name of the Father, and of the Son, and of the holy Spirit, teaching them to observe all that I have commanded you. And behold, I am with you always, until the end of the age."

Mat 28:18-20

 

 

Mudika IC Retreat Home Retreat Registration

 

MUDIKA RETREAT REGISTRATION FORM
MAY 22 - 25, 2015 - SANTA BARBARA, CA

All fields are required!

First Name

 

Last Name

Home Address

City

State

ZIP Code

Date of Birth

  (mm/dd/yyyy)

If you are younger than 16 year old by the time of the retreat, you will need to submit a completed "Release Letter" and signed by your parent or guardian.Print the form here.

Phone Number (Numbers only)

 

Area Code

Phone Number

 

Email Address

Contact Person (in case of emergency)

First Name

 

Last Name

Phone Number (Numbers only)

 

Area Code

Phone Number

 

Additional Information

Please specify for special/medical conditions (if any)

Would you be applying for a financial assistance for this retreat?

Yes

No

 

Financial Aid available upon request 

Are you a current undergraduate student?

Yes

No

 

Are you planning to drive and have space for other retreat participant(s)?

Yes

No

 

If yes, Mudika will contact you for carpool arrangements 

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