"Chosen For Such A Time As This"
Park Inn by Radisson Northampton, Silver Street, Northampton, NN1 2TA
FRIDAY 13^TH – SUNDAY 15^TH OCTOBER 2017
APPLICATION FORM

Title

Name*

First

Last

Church

Email

Address

Address 1

Address 2

City

Province/State

Postal Code

Country

Phone Number

Mobile Number

DIETARY REQUIREMENTS

Strict Vegetarian (no fish)

Vegetarian (plus fish)

Vegan

Special Diet

Intolerances - please specify:

Intolerance Description

COSTS & ROOM ALLOCATION (Price is per person) – Please tick where appropriate. NB The rooms are either single or twin-bedded. For twin-bedded, you will be sharing with another delegate. First, tick whether you would like us to assign another delegate to the room or state the full name of the person you will be sharing with, making sure they also complete their own form. Then, choose your type of room.

Let BUC assign another delegate

I will be sharing with:

Choose your Accomodation

Description	Price per Item	Tax (%)
WM Retreat Standard Twin Room	180.00 GBP	0.0
WM Retreat Single Standard Room	220.00 GBP	0.0
WM Retreat Single Superior Room	260.00 GBP	0.0

Please indicate any other requirements you may have (physical or otherwise)

Women Ministries Retreat 2017