Georgics Retreat RegistrationDianna Jensen2023-11-06T12:35:47-07:00 Georgics Retreat Registration 2024 RegistrationSelect Type(Required) Single - $1,100 Married Couple - $1,700 Are you bringing your children?(Required) Yes No Cost for children covers meals only and children may attend all classes for free.How many children are ages 0-5? Quantity Price: $0.00 Quantity How many children are ages 6-9? Quantity Price: $100.00 Quantity How many children are ages 10-13? Quantity Price: $150.00 Quantity How many children are ages 14-17? Quantity Price: $200.00 Quantity Contact InformationName(Required) First Last Phone(Required)Email(Required) Enter Email Confirm Email Spouse's Name First Last Spouse's PhoneSpouse's Email Enter Email Confirm Email Children's Name(s) and Age(s)Please list any food limitations(Required)What is your plan for lodging?(Required) Hotel in Town Tent on Campus RV on Campus* *Please be advised that RV hookups are NOT available.BillingCredit Card(Required) American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name Billing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Total CAPTCHA
