Arizona 5 Day Academy 2021 AZ 5 Day Academy 2021 AZ 5 Day Academy pre-registration form for October 24-29, 2021 Name* First Last Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Are you Clergy or Laity? Clergy Laity GenderAge Group Under 40 40 to 60 60 to 80+ What is your denomination/faith tradition?Are you a clergy member of the Desert Southwest Conference? Yes No I don't know Are you a lay member of a United Methodist Church in the Desert Southwest Conference? Yes No I don't know Have you been to an Academy for Spiritual Formation before?YesNoHave you completed the Two-Year Academy for Spiritual Formation?YesNoRegistration*Double room only available for members of the same household. Roommates need to register at the same time. Rates go up by $100 after August 15.Single Room $975 - (before Aug 15)Double Room $875 - (available only for members of the same household)Hold my spot with a $200 partial paymentRoommate Name First Last Scholarship RequestIf you are clergy or laity from the Desert Southwest Conference of The United Methodist Church, you are eligible to apply for a $100 scholarship. For information, please contact Jerry Haas, retreat leader at *protected email*. Do you want to apply for the scholarship?YesNoScholarship DonationAdditional funds are needed so that all who feel called to participate in this event may do so. If you are interested in donating, please select the option you prefer.I'm including an additional amount now with this registration.I’ll make a donation to this fund via check to Desert Southwest Conference, P.O. Box 32830, Phx, AZ 85064. Write “Academy scholarship fund” in the memo line.Scholarship Donation AmountPlease enter the amount you want to donate with your registration fee. Special Diet RequestPlease let us know if you have any dietary issues.NoneVegetarianVeganGluten SensitivityOther - Fill in belowPlease enter your diet request.Total to Pay Now $0.00 Credit CardCard Details Cardholder Name NameThis field is for validation purposes and should be left unchanged.