Men's Retreat Registration Form

Please fill out this form and click submit.

Name

Address

This address will receive a confirmation email

Phone

Emergency Contact Name

Emergency Contact Phone

Do you need a ride?

Please select one option.

Yes No

Can you drive other men to the retreat?

Please select one option.

Yes No

If yes, how many people?

Do you require gluten-free, vegetarian, or other special meals?

Please select one option.

Yes No

If yes, please specify:

We would appreciate your help! Please check the areas (if any) in which you would be able to help:

Please select all that apply.

Coordinate Carpools Clean Up Other (lead activities, etc.)

Retreat fee (check one according to your ability to pay):

Please select one option.

$255 $191 $128

Voluntary donation for scholarship help

Total: $

Method of Payment

Please select one option.

Online Pay by check (see below)

There will be a processing fee for using a credit card. Please consider adding 3% to your total to help the UUFC offset the fee.

If you plan to pay by check, please select "Pay by check later" in the drop down payment field below and please MAKE YOUR CHECK PAYABLE TO UUFC.

BE SURE TO INCLUDE “Men’s Retreat” ON THE NOTE LINE.

Mail your check to: Alan Kirk, 4180 NW Canary Place, Corvallis, OR 97330

NOTE: No Refunds after September 12, 2025 unless your space can be filled from the waiting list.

Questions? Contact: Alan Kirk at 541-602-2110 email: alan.r.kirk@gmail.com

Payment

Online Payment Pay by check later ($0)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Please fill out this form and click submit.

Men's Retreat Registration Form

Description

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