REGISTRATION PRICING:

$95 until 10/12/26

Last Chance: $110 after 10/12/26

*Registration includes 2 nights, 3 meals and all sessions

EVENT LOCATION:

Granite Hills Retreat & Conference Center, 2025 Iron Springs Rd. Prescott, AZ 86305

Registrant Name

Gender At Birth

Date of Birth

Phone Number

Church Name & City (if you have a local church)

Chi Alpha: What Campus do you attend?

Please list any other food allergies. (Note: the kitchen can accomodate many dietary restrictions, but not all. The kitchen is nut free).

EMERGENCY CONTACT INFORMATION

Name of an Emergency Contact

Relation to Emergency Contact

Phone Number for Emergency Contact

Registration Options

Running Total

$0.00

Coupon Code

Total

$0.00

BILLING INFO

Name

Credit Card

Address