Encounter Retreat (2024)

    Genesis Christian Church Encounter 2024 Registration Form

    We are thrilled that you are interested in joining us for this life-changing event. Please take a few moments to complete the registration form below. Your responses will help us ensure that your experience is as enriching and comfortable as possible.

    Important Information:

    • Dates: October 25 – 27, 2024

    • Location: Genesis Christian Church, 1490 Banks Road, Margate, FL 33063

    • Registration Fee:

    • Early Bird Payment: $80.00 (Deadline: August 15, 2024)

    • Regular Payment: $100.00 (After August 15, 2024)

    • Final Deadline for All Registrations and Payments: September 30, 2024

  • A Genesis Christian Church minister will reach out to you directly to confirm your registration and provide additional details about the retreat.

    • Section 1 of 8: Basic Contact Information

    Please select today's date *

    First Name: *

    Last Name: *

    Email (if no email, enter [email protected]) *

    Phone Number *

    What is your Gender: *

    What is your Age Range? *

    Street Address *

    Address (Line 2)

    City *

    State *

    Zip Code *

    Section 2 of 8: Marital Information

    Marital Status: *

    If applicable, will your spouse be attending Encounter? *

    Section 4 of 8: Dietary Information

    Dietary Preference: *

    Do you have any medical conditions and/or allergies we should be concerned about? (If none, enter 'N/A') *

    Do you have children? *

    Is any family member(s) attending this Encounter with you? *

    Section 5 of 8: Family Members Attending Encounter

    Please list the name(s) of the family member(s) who will be attending this Encounter with you and your relation to them. (i.e. John Smith - brother) *

    Section 6 of 8: Emergency Contacts

    Please Provide Contact Information for at least four (4) Emergency Contacts:

    Emergency Contact #1 Name: *

    Emergency Contact #1 Relationship (i.e. brother, sister, niece, etc...): *

    Emergency Contact #1 Email Address: (if no email, enter [email protected]) *

    Emergency Contact #1 Phone Number: *

    Emergency Contact #2 Name: *

    Emergency Contact #2 Relationship (i.e. brother, sister, niece, etc...): *

    Emergency Contact #2 Email Address: (if no email, enter [email protected]) *

    Emergency Contact #2 Phone Number: *

    Emergency Contact #3 Name: *

    Emergency Contact #3 Relationship (i.e. brother, sister, niece, etc...): *

    Emergency Contact #3 Email Address: (if no email, enter [email protected]) *

    Emergency Contact #3 Phone Number: *

    Emergency Contact #4 Name: *

    Emergency Contact #4 Relationship (i.e. brother, sister, niece, etc...): *

    Emergency Contact #4 Email Address: (if no email, enter [email protected]) *

    Emergency Contact #4 Phone Number: *


    Section 7 of 8: Final Comments

    Please Provide Any Additional Information or Comments