FALL RETREAT REGISTRATION IS OPEN! Fall Retreat Registration Name* First Last Email* Phone*Sex* Female Male Will you be at least 18 years old on 9/24?* Yes No: YOU WILL NEED TO GET A MINOR RELEASE FORM FROM A STAFF MEMBER Are you a part of a Core group? If so, which one?* I am not part of a Core. Ally & Katie Kylie & Hannah Briley & Mykayla Saemi & Eri Cassie & Elizabeth Andrea Rebecca & Portia Kaitlyn & Savannah Rachel & Bekah Caroline & Dena Stian Andrew & Ryan Tim & Tyler Travis & Jackson Jared & Cort Rohit & Juke Changhee & Paul Mick & Michael Mitchell & Ben Brian & Will Jadon & David Gordon & Klein Josiah & Jonathan Jacob & Ross Jessica & Laurence Emergency Contact Name* First Last Emergency Contact Phone*Please list any dietary restrictions here Please list any medications or conditions we should be aware of in case of an emergency Will you need financial assistance to be able to attend fall retreat?* Yes No Are you a returning UTD student?* Yes No, this is my first year in FOCUS at UTD Will you be staying overnight?* Yes No Which days will you be attending?* Saturday Only Sunday Only Would you like to pay for UTD Fall Retreat online now? (You can also pay in person at Fall Retreat.)* Yes, I will pay for UTD Fall Retreat now. - $40 No, I'll pay later. Would you like to pay for UTD Fall Retreat online now? (You can also pay in person at Fall Retreat.)* Yes, I will pay for UTD Fall Retreat now. - $20 No, I'll pay later. 4Would you like to pay for UTD Fall Retreat online now? (You can also pay in person at Fall Retreat.)* Yes, I will pay for UTD Fall Retreat now. - $25 No, I'll pay later. 3Would you like to pay for UTD Fall Retreat online now? (You can also pay in person at Fall Retreat.)* Yes, I will pay for UTD Fall Retreat now. - $15 No, I'll pay later. 2Would you like to pay for UTD Fall Retreat online now? (You can also pay in person at Fall Retreat.)* Yes, I will pay for UTD Fall Retreat now. - $12 No, I'll pay later. 1Would you like to pay for UTD Fall Retreat online now? (You can also pay in person at Fall Retreat.)* Yes, I will pay for UTD Fall Retreat now. - $8 No, I'll pay later. If you would like to include a scholarship to help other students pay for UTD Fall Retreat, you can enter the amount here. *Once everyone is paid for, any leftover funds will be transferred to the general fund to further the mission of FOCUS. Total $0.00 Credit Card*Card Details Cardholder Name
