Couple’s Retreat – Registration Form Into His Embrace – Breaking Free Couple's Retreat - Carmine, TX - Feb 6-8, 2025 "*" indicates required fields Step 1 of 9 11% SPRING COUPLES RETREAT - CARMINE, TX IMPORTANT, PLEASE READ!!!!COUPLES, PLEASE NOTE: EACH SPOUSE MUST REGISTER SEPARATELY IF BOTH PLAN TO ATTEND THE RETREAT. THIS ENSURES THAT ALL PAYMENTS AND REQUIRED FORMS ARE COMPLETED DURING THE REGISTRATION PROCESS. TO ENSURE A SMOOTH REGISTRATION PROCESS, PLEASE COMPLETE EACH SECTION AND SIGN & SUBMIT ALL REQUIRED FORMS. REGISTRATION IS NOT COMPLETE UNTIL ALL REQUIRED FORMS HAVE BEEN SUBMITTED.REGISTRATION - PART 1To complete registration, both you and your spouse must fill out individual registration forms and submit separate payments if you both plan to attend the retreat.Contact DetailsName* First Last Email* Enter Email Confirm Email Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands REGISTRATION - PART 2ATTENDEE INFOGender*MaleFemaleAge*16-2425-3435-4445-5455-6465+How did you hear about this event?*Social MediaGoogleWord of MouthRefer a FriendPast ParticipantOtherWhy do you want to attend this retreat?*What do you expect to receive from this retreat?*Have you accepted Jesus Christ as your Savior?* Yes No How would describe your current relationship with God?* Strong and deeply connected Growing and seeking Lukewarm and inconsistent Uncertain What church do you currently attend?* REGISTRATION - PART 3-AView and Complete the Liability Waiver Release Form REGISTRATION - PART 3-BDID YOU SIGN & SUBMIT THE LIABILITY WAIVER RELEASE FORM?* Yes, I Read, Signed and Submitted the Liability Waiver Release Form Select AllIF YOU DID NOT COMPLETE THE REQUIRED LIABILITY WAIVER RELEASE FORM, PLEASE DO THAT BEFORE PROCEEDING TO THE NEXT STEP.View and Complete the Liability Waiver Release Form REGISTRATION - PART 4-AView and Sign the Media Release Form REGISTRATION - PART 4-BDID YOU READ, SIGN, AND SUBMIT THE MEDIA RELEASE FORM?* Yes, I read, signed and submitted the Media Release Form Select AllIF YOU DID NOT COMPLETE THE MEDIA RELEASE FORM, PLEASE DO THAT BEFORE PROCEEDING TO THE NEXT STEP.View and Sign the Media Release Form REGISTRATION - PART 5-AMEALSAs part of the retreat experience, all meals will be catered (brought in), with breakfast provided by Abba's Heart Encounters. Dinner on Friday night will be out at Duo Restaurant. SNACKSPlease sign-up to bring a snack to share to help enhance the fellowship and shared experience during our time together. Please use the link below to sign up:CLICK TO VIEW & SIGN-UP TO BRING A SNACK REGISTRATION - PART 5-BDID YOU SIGN-UP TO BRING A SNACK?* Yes, I Signed Up To Bring A Snack To Share Select AllIF YOU DID NOT SIGN-UP TO BRING A SNACK, PLEASE DO THAT BEFORE PROCEEDING TO THE NEXT STEPCLICK TO VIEW & SIGN-UP TO BRING A SNACK REGISTRATION - PART 6Payment DetailsProduct Name Price: Carmine, TX - Couples Retreat: Includes lodging, all materials, and meals (except for one meal on your own).Total Credit Card* Abba's Heart Encounter Spring 2025 Couples Retreat in Carmine, TXCAPTCHA
