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Steubenville 2023

Steubenville 2023Noor Atisha2023-03-05T21:19:00-05:00

"*" indicates required fields

All fields are required to submit application.

Retreatant Information:

Student Name

Student and Parent Contact Information:

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Address*
Do you have a coupon code?*
Includes conference admission, transportation, lodging, all meals and 2 group t-shirts.
*Note: Initial charge of $200 will be collected upon submission and the remainder of $200 will be collected on the same card after 30 days.
Authorization For Two Payments*
By checking this box, I, the authorized card-holder of the credit card entered below, authorize ECRC to automatically deduct $200 now and $200 one month from now. I will not hold ECRC liable for any unauthorized billing charges. If the payment fails the second time, I am still responsible for providing the remainder of the amount due, otherwise this registration may not be valid for attending the retreat.
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Credit Card*
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Supported Credit Cards: American Express, Discover, MasterCard, Visa
Expiration Date
 
Address*
Terms & Conditions*
There is certain behavior and certain expectations that are encouraged on this journey. I understand that this journey is to focus on my personal relationship with God. I agree that if I am found in possession of or participating in any way with drugs or alcohol, parent/guardian will be called and I will not be allowed to participate in any activities socially, only spiritually. I further understand that this is a coordinated by our Catholic Chaldean Church and I am expected to participate in all planned meetings and activities and abide by all rules. By checking the box above, I am agreeing with all terms mentioned and all my information that I completed above is true.

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