Youth Winter Retreat Registration SMBC Youth Winter Retreat Registration Church InformationChurch Name* Church Phone*Contact Name* Contact PhoneEmail* Would you like to to receive the registration packet by e-mail or postal mail?* E-mail Mail to the address below Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code 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 Country Weekend RequestedFirst Choice* New Year's Eve Retreat (Mon, Dec. 31 - Wed., Jan 1) Martin Luther King, Jr. Weekend (Sat., Jan 18 - Mon., Jan 20) Second Choice (if your first choice is full)* New Year's Eve Retreat (Mon, Dec. 31 - Wed., Jan 1) Martin Luther King, Jr. Weekend (Sat., Jan 18 - Mon., Jan 20 None, I can only attend my first choice. Cabin PreferenceHope Haven - 16 beds (2 rooms of 8)Wilkies Grove - 18 beds ( 3 rooms of 6)Faith Lodge - 28 beds ( 2 rooms of 6, 2 rooms of 8)Lincoln Avenue - 28 beds (upstairs: 2 rooms of 6; downstairs: 2 rooms of 6, main room 4 beds)Pleasant Brook - 28 beds (2 rooms of 6, 2 rooms of 8)Harris Fellowship - 44 beds (upstairs: 1 side for 12, 1 side 14; downstairs: 2 rooms of 10)Pleasant Hill - 49 beds (1 room of 22, 1 room of 23, 2 rooms of 2)I have no preferenceCabin Assignments are based on group size and the order deposits are received. We cannot guarantee request, but will consider your preference when making assignments if possible. Camper InformationNumber of campers attending *Note: Chaperones are required at a ratio of 1 adult per 6 campers. Coed groups REQUIRE coed chaperones.Female Campers*Female Chaperones*Male Campers*Male Chaperones*Total*Deposit InformationA deposit of $50 is required for each person (campers & chaperones) to confirm your reservation by September 9, 2024. This deposit is NOT refundable under ANY circumstance. One deposit is applied to each camper fee, extra deposits may NOT be applied to a group's balance. The total cost for this retreat is $135/person Deposits may be made with check or money order payable to: South Mountain Baptist Camp 3558 Baptist Camp Rd Connelly Springs, NC 28612I have read, understood, and agree to the registration policies listed on this form.* Yes Authorized Church Representative's Signature*Printed Name*
