Poiema Retreat

Registration Form

We are so excited you want to be a part of the 2016 Poiema Retreat! Please fill out the form below, and then follow the instructions to pay at the end. You can find more information about the retreat schedule, what to pack, and other important retreat news on the Poiema Group on The City. Registration questions can be sent to lea@terranovachurch.org.

About You
Please tell us a little about you.
Name*
First Last
Email*
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Address*
Street Address City State
Phone*
Emergency Contact Name*
First Last
Emergency Contact Phone*
Which Terra Nova Church are you a part of?*
REQUESTED ROOMMATES | Rooms accommodate 2-3 peope, so please note the names of those you would like to room with; it also really helps us if you coordinate with the people whose names you write. If you don't know many people at Terra just leave this spot blank, and we will make sure to put you with other awesome women!
Also, please use this space to note any special circumstances (nursing mothers, health concerns, etc.). We cannot guarantee that all requests will be honored, but we will try our best to do so.
FOOD ALLERGIES | Silver Bay has a cafeteria-style kitchen and will attempt to prepare a variety of foods to accommodate different diets. Please indicate below your food/dietary restrictions.
Note: If you have severe food allergies, we recommend you bring food specific to your diet for your own safety as this is a mixed-food prep kitchen. There are a few refrigerators available, so please make sure to note that you will be bringing your own food.
SERVE | Use Your Gifts
There are a number of ways that all of us can pitch in and serve each other at the retreat. It might be preparing snacks, cleaning up after the retreat party, helping with retreat atmosphere, etc. If you would like to serve please follow the link below to The City and choose a volunteer role that you can help fill. Sign up HERE
Scholarship Fund Donations
We want as many Terra Nova women as possible to go on this retreat. Some will have a difficult time finding $165 in their budgets. Would you be willing to help offset the costs for another lady at Terra Nova? If so, please let us know how much you'd like to donate in the field below and then follow the instructions regarding how to make that donation during the registration payment process. Donations to the Retreat Scholarship Fund are tax-deductible.
Please indicate how much you'd like to donate towards the Retreat Scholarship Fund here:
Scholarship Fund Requests
Please send an email to request a retreat scholarship. Funds will be awarded to deserving Terra Nova women based on availability and need. We do ask that scholarship recipients pay at least $50. Also, please do not complete this registration process until after you have emailed life@terranovachurch.org. Once you have been awarded a scholarship, you will then receive an email so you know what amount to include below as your registration payment. Thank you for your patience and understanding.
Retreat Registration Payment
2016 Poiema Retreat*
Price: $165.00
This price covers two nights of lodging, guest speakers, meals and recreation.
NOTE: If you need to cancel for any reason, we will only be able to refund your fee if we are able to sell your spot to someone else. Thank you for understanding.
I promise to follow the links and instructions that follow to pay in ful on The City.*
- Yes
- No
Remember, your space at the retreat is not confirmed until your payment has been received. Detailed instructions on how to complete the payment process will be on the page after you click "Submit" below.
Name
This field is for validation purposes and should be left unchanged.

Poiema Retreat

Registration Form

About You

SERVE | Use Your Gifts

Scholarship Fund Donations

Scholarship Fund Requests

Retreat Registration Payment

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