Main Street Church
Bind Us Together
10th Annual Women's Retreat
May 4-6, 2018

NOTE: Online registration and online payment are TWO SEPARATE & DIFFERENT ACTIONS.

Action 1: Fill out the form with all the appropriate information and then click on "Submit". (If you are registering for more than one person, please fill out the form and submit for each person individually.)

Action 2: On the page that comes up, you will have the option of submitting your payment online via credit card by way of Main Street Church's online payment gateway. Your payment will then be processed and earmarked for your registration. If you have any questions, please contact us.

Your Name

Street Address
City, State & ZIP
Your E-mail:
Church affiliation OR
Friend you're registering with:
To help us better serve & accommodate all attendees, please check all that apply:

I am:      An Early Riser         Early to Bed       A Night Owl        A Snorer

I prefer: Top Bunk        Bottom Bunk       I'm willing to share a Queen bed with:

I would like to room with the following THREE women:

Please indicate any special or physical needs, including ability to climb stairs, dietary restrictions or food allergies, etc.:

We will do our best to accommodate needs and preferences, but cannot guarantee it.




Main Street Church of Brigham City
©2018 by Main Street Church of Brigham City    •
48 North Main Street    •    Brigham City, Utah  84302
Tel: (435) 723-6469   •    Fax: (435) 921-0426


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