Join us on the Senior Overnight Retreat this year!

The cost to attend is $50, which includes transportation, housing, food, and materials for the retreat.

Please do not let the cost stop you from coming - scholarships are available!

For any questions about the retreat or to inquire about scholarships,

contact Campus Ministry for more info.

Tickets	Price
General Admission	$50.00 (+ $0.00 fee)

Total: $0.00

Scholarship Code

Total

$0.00

Participant Registration

Name

CUA Student ID#

CUA Email

Student Phone Number

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Date of Birth

Gender

Male
Female

T-Shirt Size

For Dietary Restrictions and Allergies, if there are none please enter N/A.

Dietary Restrictions

Allergies

Emergency Contact Information

Name

Address

Parent/Guardian Email

Phone Number

Relationship to Participant

Health Insurance Information

Health Insurance Provider

Insurance Policy Number

Insurance Group Number

Billing Information

Name

Payment Method

Credit Card
Check or Cash

Credit Card

Visa
Mastercard
American Express
Discover

Address

Mobile Phone Number

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SENIOR RETREAT

Join us on the Senior Overnight Retreat this year!

General Admission

Participant Registration

Emergency Contact Information

Health Insurance Information

Billing Information