2019 Academy for Spiritual Formation

Contact Information
*First Name
*Last Name
Preferred Name
*Address 1
Address 2
*City
*State
*Zip
*Phone
*Email
*Are you clergy?
Yes
No
*Home Church?
*What is your current occupation?
*Age Group?
25-29
30-39
40-49
50-59
60+
*Is this your first Academy?
Yes
No
*I have experience/interest in leadership in the following areas:
Please select all that apply.
Worship
Singing
Musical Instruments
Small Group Facilitation
None of the Above
If you selected musical instruments, please list instruments with which you have experience below.
*Would you be willing to share your abilities during the Academy?
Yes
No
*Do you have any special dietary needs or restrictions?
Yes
No
If you answered "yes" above, please list dietary needs/restrictions below.
*Do you have any special housing needs? Ex: a loud CPAP machine that requires you be in a room alone, a medical reason for needing a downstairs/handicap accessible room, etc.
Yes
No
If you answered "yes" above, please list your housing needs below.

This includes specific roommate requests.

*Lodging Request

*A $75 deposit is required at the time of registration to secure your room preference.

Due to a limited amount of space, only 20 private rooms will be available on a first-come, first-served basis. Once these rooms are full, participants will be placed in double-rooms and charged the double-room rate.

Double Room ($255 early | $275 standard) ($255)
Single Room ($280 early | $300 standard) ($280)
Scholarship Donation

If you would like to contribute to the Academy Scholarship fund, please feel free to do so below. Contributing to this fund offers those who may be unable to attend The Academy due to financial constraints the opportunity to worship, study, and retreat with us.

$
Only number values are allowed
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