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Give an Abused Woman Hope & 
The Opportunity to Change Her Life!

Registration Form:
I Want To Attend The Women's Retreat On June 8-10, 2018

        I Want Lodging so I am Paying:         $169.99 In Full           $50 Deposit
        I Do NOT Want Lodging so I'm Paying:       $129.99 In Full         $50 Deposit


  Last Name:                                               First Name: 

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  Home Phone: (         )            -                Registration Date:         /        /

  Church Name & Location:

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A Non-Refundable Deposit Of At Least $50.00 
Must Be Made Today To Complete This Registration! 

(Until Payment is Received Your Registration is NOT Complete & Your Space is NOT reserved!)

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The Life You Save (UNKNOWINGLY) May Be Your Loved One's!
Do You Have A Heart For The Hurting?
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(727) 226-9469
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