Registration Form - Lamenting Faith Retreat Ministry

First Name

Enter your first name.

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Last Name

Enter your last name.

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Spouse Name

Spouse’s name (only if spouse will be accompanying you)

This field is required.

Name(s) of your Child(ren) Who Died

This field is required.

Phone Number

Enter your phone number for contact purposes.

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Confirm Phone Number

Re-enter your phone number for confirmation.

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Email Address

Enter your email address

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Confirm Email Address

Re-enter your email address for confirmation.

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Address

Enter your address including city and state.

Address Line 1

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Address Line 2

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City

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State

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Zip Code

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Country

Home Church

Enter the name of your church, if applicable.

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Please tell us about your family…including the child(ren) who died and the circumstances of their death

Include as much or as little detail as you wish

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What are you most hoping to gain by attending this retreat?

This field is required.

Do you have any mobility issues or health concerns of which we need to be aware?

If so, please explain. If not, you may leave this section blank