West Virginia Disciples Men's Retreat  
Early Bird Discount on Registration Fee Ends  Sept. 10  
Download paper registration form on our Men's page.
Online Registration and Payment:  
You may register using the form below and mail your check to
"CCWV", 1402 Washington Ave., Parkersburg, WV 26101,
or
pay by Paypal or credit card  (The site will indicate you are making a "donation." Please enter the total from below.)
Online Retreat Registration
* Required Field
Your name:
Address:
*
*
State:
Zip Code:
City:
*
*
*
Church
City:
Church
Name:
*
*
Other Ph:
Home Ph:
Cell Ph:
Email:
*
Cost Summaries:
Carefully follow instructions below, and indicate whether you are mailing a
check or paying online.  Instructions will be sent to you for online payment
within 3 days of receiving your completed information.
Lodging Rates
Dormitory Housing (4-6 persons per room)
$14 Friday (per person)
$14 Saturday (per person)

Budget Motel (2 persons per room)
$50 Friday (private)
$25 Friday (per person)
$50 Saturday (private)
$25 Saturday (per person

Holt Lodge (2 persons per room)
$38 Friday (per person)
$77 Friday (private)
$38 Saturday (per person)
$77 Saturday (private)
LODGING:



MEALS:



REGISTRATION:
$35
No charge for
up to age 30


TOTAL DUE:
From the cost guide at left, please indicate
your Lodging choice in comment box below,
indicating which night(s) and total due.  
From the cost guide at left, please indicate
your Meal choices in comment box below,
indicating total due:
Add $35 per participant over age 30
Before Sept. 10:  enter $30
Meals
$9.00  Friday Dinner  
$6.25  Saturday Breakfast
$7.75  Saturday Lunch
$9.00  Saturday Dinner
$6.25  Sunday Breakfast
$7.75  Sunday Lunch
Indicate total due, and please
double-check your math:
Method of Payment:
I will mail a check (before Sep. 25)
Please send instructions for online
payment (you must include your email
address for this option)
Details, room-mate requests,  comments, or feedback:
Room-Mate Requests:
Please indicate your choice of
room-mate and be sure to check with
that person, so that they will indicate
your name.  Use comment box at left.
Thank you for your participation.
If you have trouble with the online
registration system, please contact
Rev. David Chafin at 304-417-1248 or
email him.