First Name
Last Name
Phone Number
Email
Address
Apartment, suite, etc.
City
State
Zip/Postal Code
Retreat Activity: name of event you would like to attend
Attendee Name
ATTENDEE'S birthdate
Gender
Male
Female
I'd rather not say
Mount Hermon Sponsored Event: If this event is sponsored by Mt. Hermon, have you applied for their Campership Assistance Program? Please note: this is required for Fall Frenzy.
Affordable Amount: Enter the amount you are able to share in the cost of the trip or event.
Explanation: briefly state the circumstances making assistance necessary. Note: this application will be reviewed / approved by a Pastor.
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