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Matt Talbot Group 142 - 17th Retreat
Retreat Dates: April 24th – 26th 2015
Name:
___________________________________
Address:
___________________________________
City: State: Zip: __________________ ____ ________
Phone: Cell: ________________ ______________
Email: ____________________
Is this your first Matt Talbot 142 retreat?
Y___ N ___
Are there any changes to your contact info? Circle one: Y / N
Would you like to volunteer?
Coffee
Registration
Set-up/Breakdown
Hospitality
Matt Talbot Group 142 provides a limited number of partial scholarships for those who
may not otherwise benefit from attending the retreat. Scholarships are made available
through the generosity of our fellow members.
Please indicate the amount you would like to contribute to a scholarship: $20 __ $50 __
$100 __ $170 __ (other) $ ____
Summary of Fees: please check one:
Private Room: $225
Double Room: $170…….Do you have a preferred roommate?
Roommate name here: ____________________________________
Scholarship: $ _______ (optional)
Total enclosed: $ ______
Please submit Registration by March 31,2015
Payments are non-refundable but may be transferred to someone else.
Registration is first come first served. Payment will be returned if retreat
reaches capacity.
Remit payments to: Matt Talbot Group # 142
2879 HWY 160 West - P.O. Box 4862
Tega Cay, SC 29708
Call Ben J. For Details 803-517-8305
We look forward to seeing you there!