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* 1. Name (First and Last)

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* 2. Email & Phone

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* 4. How long are you staying?

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* 5. Will you require a handicap accessible room?

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* 6. Male or Female?

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* 7. Will you be sharing a room with someone? (i.e spouse, parent, etc?).

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* 8. Did you receive a scholarship? If so, for how much?

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* 9. Did you pay via PayPal or will you be paying with cash/check on site?

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* 10. Would you like to donate to the retreat fund to help provide scholarships for those who need them? If so, how much?

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