The
Registration Form
Please complete, print and mail with your check made payable to Silverbrook UMC to:
Silverbrook UMC
Your name: ___________________________________________________
Address: ______________________________________________________
Email(so that we might send you reminders and updates): __________________________________________________
Do you wish to be on the permanent retreat notification email list?
Yes ______
No ______
Home phone: _________________ Cell Phone: _____________________
Which is preferable if we have to get in contact with you for emergency cancellations etc? (Please indicate with a check mark)
Church or religious affiliation: ______________________________________
Please indicate the date of the retreat for which you are registering: _________________
QDR ($25) ___________ or RD ($40) ____________
How did you hear about our retreat ministry? ___________________________
Please remember to enclose your full payment to the address above.
Please remember to check the website for further details: www.silverbrook-umc.org. If you have any questions you may call Pastor Kim Barker-Brugman at 703.690.4159 or email: Pastor@Silverbrook-umc.org.