GEORGIA DISTRICT WOMEN’S RETREAT

November 2-4, 2007

Carolyn Brand, Director

770 565-8936

Please complete the following registration information and mail directly to:

Lois Smithwick, Registrar

910 Anderson Street

Dublin Georgia 31021

478 274-9053 (Home)

NOTE: Please do not send forms directly to Adrian Camp. All pre-registration is

handled by Lois Smithwick, at the above address.

Church_______________________________________________________________

Name_________________________________________________________________

Address_______________________________________________________________

Phone: Day__________________________Evening_________________________

LODGE PREFERENCE:

Latham Lodge	($65 per person, 4 per room) ____ ($75 per person, 2 per room) ____
Duncan	($50 per person) ____
Eason	($50 per person) ____
Anderson	($50 per person) ____
Smith	($50 per person) ____
Lodge II	($50 per person) ____
Private Cabin	($40 per person) ____

An additional charge of $10.00 per person will be added to the above rates for all

Pre-registration postmarked after October 12, 2007.

(PLEASE COMPLETE ITEMS BELOW, IF APPLICABLE)

I will not arrive in time for Friday evening meal____

I will not arrive until Saturday_______I will not be staying Saturday night_______

I prefer to room with____________________________________________________

I need first floor__________________Dietary restrictions______________________

Along with this form, please submit your $20.00 deposit, per person, by October 6, 2007. Registration will begin at 3:00 pm, November 2. All deposits are non-refundable and non-transferable. Dress is casual! Sorry, no children.

If after pre-registering, you find you will not be able to attend, please notify Lois Smithwick so that someone on the waiting list may be assigned your room. Thank you!