ENCOUNTER Weekend Registration 2022 July-Dec
Provided by the GAP Ministries (Pastor Jackie Greene)
Olde Sassafras Farm Bed N Breakfst
181 Henry Road
Cherry Tree, Pa 15724
Arrive Friday @ 6:00pm
Depart Sunday @ 11:00am
Please fill out this form and click submit at the end.
Personal Details
Name
*
Phone
*
Email
*
This address will receive a confirmation email
Event Details
Choose an Encounter Weekend
*
Please select one option.
Sep 23rd to 25th
Oct 14th to 16th
Select Option
Sep 23rd to 25th
Oct 14th to 16th
List any dietary restrictions
Payment Details
If you have already paid for registration by cash/check directly to Jackie, please select the cash/check option below and proceed to submit the form. Thank You.
Payment
Single Registration ($225.00)
Cash/Check Registration (0)
Single Registration ($225.00)
Cash/Check Registration (0)
Amount
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
Description
Provided by the GAP Ministries (Pastor Jackie Greene)
Olde Sassafras Farm Bed N Breakfst
181 Henry Road
Cherry Tree, Pa 15724
Arrive Friday @ 6:00pm
Depart Sunday @ 11:00am
Please fill out this form and click submit at the end.
×
Please Fix the Following