REGISTRATION

36TH ANNUAL SPIRITUAL RETREAT
JANUARY 15-18, 2026
$285.00 REGISTRATION COST INCLUDES FOOD, LODGING, & ALL ACTIVITIES

Registration due by December 31, 2025. To ensure your participation and to secure your spot, please complete the registration process before this deadline. Timely registration allows us to effectively plan and accommodate all participants, enhancing the overall experience.

EACH REGISTRATION FORM IS FOR ONE REGISTRATION.

IF REGISTERING FOR MULTIPLE PEOPLE, PLEASE FILL OUT AND SUBMIT ONE FORM FOR EACH REGISTRANT.

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BE OR TOP

NAME *

First

Last

AREA

tell us where you’re coming from!

EMAIL *

PHONE NUMBER *

GENDER *

• MALE
• FEMALE
• NON-BINARY
• OTHER

CLEAN DATE *

ARE YOU REQUESTING A SCHOLARSHIP? *

• YES
• NO

If YES– please send a letter stating why you would like to be considered for a scholarship to RETREAT@PALMCOASTNA.ORG

*PLEASE NOTE: Scholarships will be selected the first Saturday of December.*

*PLEASE NOTE: Cabin and/or Bed choice may be selected for you.*

DID YOU REVIEW THE AVAILABLE CABINS AND BEDS LINK AT THE TOP OF THIS PAGE? *

• YES
• NO

IF NO, PLEASE REVIEW BEFORE CONTINUING TO THE NEXT SELECTION TO ENSURE WHAT YOU ARE WANTING IS STILL AVAILABLE.

CABIN SELECTION *SELECT CABIN NAMEREQUESTING SCHOLARSHIPLODGE 1- WOMEN__________SurrenderPatienceFaithAcceptanceHopeCourageIntegrityWillingness__________LODGE 2-MIXED__________Humility (WOMEN)Unity (WOMEN)Open Mindedness (Men)Wisdom (Men)Serenity (Men)Service (Men)Honesty (Men)Gratitude (Men)__________RIVERSIDE DORM__________Compassion (Women)Unconditional Love (Gender Neutral/LGBTQ+ Inclusive)

TOP OR BOTTOM BUNK *

• TOP
• BOTTOM
• REQUESTING SCHOLARSHIP

DIET CHOICE *

• REGULAR
• GLUTEN FREE
• VEGETARIAN

WILLING TO BE OF SERVICE? *

• YES
• NO

WILLING TO:

• CHAIR A MEETING
• SHARE AT A MEETING

Submit