Men's Retreat

Men's Retreat (14 spots left)

Location: Villa Maria del Mar in Santa Cruz

Dates: January 15-17

Speaker: Scott Palmbush

Cost: $490 for single room; $395 for double room. Partial scholarships are available--please ask!

NOTE: Payment is non-refundable.

Contact: Curt Taylor, curt@taylorsinpv.com

* First Name

* Last Name

* Email

* Mobile Phone

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* Address

Address 2 (Apt/Suite # etc.)

* City

* State/Province

* Zip/Postal Code

* Your choice of accommodation

Single room ($490.00) [10 left]

Double room ($395.00) [4 left]

If you chose a double room, please list the name of your roommate.

* Emergency Contact Name

* Emergency Contact Phone

NCC WAIVERS

Please read and agree to the following.

Liability Release for adults

I warrant and represent that I am eighteen years of age or older, and I indemnify and hold harmless, release and discharge New Community Church, its constituent organizations, and its officers, agents and employees from any and all claims for personal injuries, property damage or wrongful death that I may suffer as a result of my participation in the activity described above, whether or not such injuries or damages are caused by the negligence (active or passive) of any of the entities or individuals named or described above.

* Liability Release agreement

I agree

Medical Consent for adults

I agree that in the event I am injured as a result of my participation in the activity described above, including transportation to and from the activity, that I shall be responsible for payment of any hospital, medical, dental or related costs and expenses, and to reimburse New Community Church for any of these expenses paid on my behalf. I consent to any necessary medical care and treatment in the event of injury, including but not limited to, diagnostic studies, anesthesia, and surgical intervention.

* Medical Consent Agreement

I agree

Photo Release for adults

I authorize the making of photographs, motion pictures, videotapes, recordings or other memorializing of said event and my participation therein, and the publication or other use thereof. I waive any right to compensation or any right that I otherwise might have to limit or control such.

* Photo Release Agreement

I agree

SCHOLARSHIP FUND--Men's Retreat

If you would like to make a tax-deductible donation of any amount to the scholarship fund, please CLICK HERE.

SCHOLARSHIP

If you have received a scholarship, please enter promo code below.