River Region Couples Retreat 2024 Sign up sheet for the River Region Couples Retreat Primary Contact Name(Required) First Last Primary Contact E-Mail(Required) Secondary Contact Name(Required) First Last Secondary Contact E-Mail(Required) Home Congregation(Required) Billing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Payment Type Pay by Debit/Credit Card Please make checks payable to Faulkner University. Pay Full Amount? Yes No add_filter( ‘gform_field_validation_101_22’, ‘donate_minimum_validation’, 10, 4 ); function donate_minimum_validation( $result, $value, $form, $field ) { $min_amount = 25.00; $donated = str_replace(‘$’, ”, $value); if ( $donated < $min_amount ) { $result['is_valid'] = false; $result['message'] = 'A minimum amount of $'.$min_amount.'.00 is required to reserve your spot.'; } return $result; }Enter Amount to be paid today.(Required) Minimum Amount of $100.00 is Required to Reserve a Spot. Registration Fee Price: Total Credit Card(Required) American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged. Skip back to main navigation
