East Texas Baptist Encampment
2011 Registration Form
All Ladies Retreat
Due on or before Feb. 14, 2011
Please fill out completely: receipts and information is sent via email.
Church Name_________________________________ Church Phone_________________________
Church Address______________________________ Church email__________________________
Contact Name________________________________ Contact Phone_________________________
Contact Address______________________________ Contact email__________________________
# Number of People (i.e. 1 double room has 2 people put 2 in the blank)
A. Lodging
Double room # of rms.___ # _____ X $25.00= ________
Triple/Quad room # of rms.___ # _____ X $20.00= ________
Dorm # _____ X $18.00= ________
B. Commuter
Friday #______X $ 5.00= ________
Saturday #______X $ 5.00= ________
C. Meals
Fri Dinner #______X $ 7.50=________
Sat. Breakfast #______X $ 7.50=________
Sat. Lunch #______X $ 7.50=________
D. Program Fee
Total number of commuters and over night guest #______X $15.00=________
E. Deposit Due Total Number attending #______X $ 20.00=_________
Deposit is non-refundable
Deposit is subtracted from total amount with the balance due on or before arrival.
A. + B. + C. + D =_______________-deposit $__________=_________Balance
Please send one check for the total deposit amount.
Make checks payable & Mail to: ETBE ~178 Private Road 7005 ~ Newton, TX 75966
www.etbe.org http://www.etbe.org phone 409-379-2737
Office Use:
Date Received____________________ Check #____________________ Check Amount_____________________