Register By Mail
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Register at least one month prior to the event, if possible. Please print clearly and use the same name on all subsequent correspondence. If we do not receive two weeks notice of cancellation, your deposit cannot be refunded.
City, State & Zip________________________________________________________
Home Phone ________________________ Work Phone __________________________
Cell Phone ________________________ E-mail _______________________________________
 Female  Male Roommate request (all double rooms) _______________________________
I am paying by check: Amount enclosed $_____________If you are paying by check send 1/2 of the total amount as a deposit. Please round the amount to the nearest dollar.
Visa, Mastercard, Discover: Amount of payment $_________ (must be full amount if paying by credit card)
Card no.______________________________ Exp. date ____________
For Canadian checks please indicate “US funds” next to the dollar and word amount.
Mail to: Kirkridge Retreat Center, 2495 Fox Gap Road, Bangor, PA 18013 PHONE 610-588-1793 FAX (610) 588-8510.