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Assemblies of God Northern California and Nevada District

2008 Mt. Lassen Prayer Retreat: Registration Details

To register for the 2008 Mt. Lassen Prayer Retreat, please complete the following form. When you click the Submit button, you will be taken to a page which will enable you to add various options to our PayPal shopping cart. If you have any problems, please don't hesitate to .

It is very important that the details you enter here (name, street address, etc.) match the information you enter into the PayPal shopping cart on subsequent pages. This will allow us to match your registration details with your payment.

Name:

Street Address:

City:       State:       Zip Code:
         

Phone:

Email:

Home Church:

List Roomates
(4 for dorm room, 1-5 for cabins, all accomodations have bunkbeds)

Roommate 1:

Roommate 2:

Roommate 3:

Roommate 4:

Roommate 5: