Registration Couples Retreat Couples Retreat is for adults of 18+. with a cost of $320. Register before early bird deadline and get an early bird price of $260. 1 Personal Info2 Payment Select a Camp & DateCouples Retreat 2019*Couples Retreat 1 - May 24, 2019 to May 26, 2019(Early Bird Deadline: April 24, 2019)Couples Retreat 2 - September 6, 2019 to September 8, 2019(Early Bird Deadline: August 7, 2019)Registrant InfoName* First Last Date of Birth* Address* Address City State / Province Zip Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Email* Enter Email Confirm Email This is also where your registration information will be sent.Cell Phone*Home PhoneWork PhoneSpouse's InformationSpouse's First Name*Spouse's Birth Date* Wedding Anniversary Date* Church InfoChurch NameChurch Location City State PastorGroup LeaderSpecific Housing RequestFull payment and completed registration form required: to reserve a specific housing unit you must complete this registration form along with full payment for each person requesting the unit. Please note housing is assigned as full payment is received. Some units will be reserved as much as a year in advance. We reserve the right to reassign rooms to those who have mobility needs, even if you have paid in full for that room. NOTE: This is only if absolutely necessary. We make every attempt to house you as requested when you pay in full.1st ChoiceBereaElimFairhavenGrace HouseHance HouseMamreNarniaNash HallRamahVillage Cabin2nd ChoiceBereaElimFairhavenGrace HouseHance HouseMamreNarniaNash HallRamahVillage CabinComments or RequestsHave you previously attended a retreat, camp or other event with Cedine Ministries?YesNo Camper Agreement* I understand and agree to abide by all the camp policies Refund and Transfer Policy* I have read and understand the refund and transfer policy. I agree that the submission of this online form, along with my payment, indicates that I understand the refund and transfer policy. Transfers to another retreat MUST be made at least 14 days before the registered retreat begins. The payments are transferable to another retreat this year or next year depending on availability as long as you have given a 14 day notice. You may transfer payments to an unregistered person if you are unable to attend. No payments may be transferred to a person who is already registered. If you are unable to attend, cannot transfer it to an unregistered person, and have not notified us at least two weeks prior to the retreat, your money is not refundable or transferable.PaymentSelect Amount to Pay*Since it's before December 31, 2016, you can pay the 2016 early bird price for 2017 retreats if you pay in full. Couples Retreat 1 - May 26, 2017 to May 28, 2017Pay in Full - CR1 ($70 Off) - $260.00Pay a Deposit - CR1 - $160.00Select Amount to Pay*Since it's before May 3, 2019, you get an early bird discount if you pay in full. Couples Retreat 1 - May 24, 2019 to May 26, 2019Pay in Full - CR1 ($60 Off) - $260.00Pay a Deposit - CR1 - $160.00Select Amount to Pay*Couples Retreat 1 - May 24, 2019 to May 26, 2019Pay in Full - CR1 - $320.00Pay a Deposit - CR1 - $160.00Select Amount to Pay*Since it's before December 31, 2016, you can pay the 2016 early bird price for 2017 retreats if you pay in full. Couples Retreat 2 - September 8, 2017 to September 10, 2017Pay in Full - CR2 ($70 Off) - $260.00Pay a Deposit - CR2 - $160.00Select Amount to Pay*Since it's before August 7, 2019, you get an early bird discount if you pay in full. Price is per couple. Couples Retreat 2 - September 6, 2019 to September 8, 2019Pay in Full - CR2 ($60 Off) - $260.00Pay a Deposit - CR2 - $160.00Select Amount to Pay*Couples Retreat 2 - September 6, 2019 to September 8, 2019Pay in Full - CR2 - $320.00Pay a Deposit - CR2 - $160.00Credit Card Info American ExpressDiscoverMasterCardVisa Card Number Expiration Date Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Security Code Cardholder Name If you have a coupon code, enter it here Cedine verifies coupons for each registration. If you are using a coupon without authorization, you will be responsible for full payment of fees.Total $0.00 Your credit card will be charged when you click submit.