Arizona 5 Day Academy 2021 AZ 5 Day Academy 2021 AZ 5 Day Academy pre-registration form for October 22nd-27, 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* GenderAre you Clergy or Laity Clergy Laity What is your denomination?Pre-Registration Fee*Hold my spot with a $200 partial paymentSave the dateYou can save the date and be added to the 2021 Academy mailing list, or make a $200 refundable deposit for a spot now. The $200 can be refunded up to August 1st 2021.Scholarship Form RequestDSC clergy may apply for scholarship assistance with the Conference Board of Ordained Ministry. Some scholarship funds are available for laypersons from the Desert Southwest Conference. For information, please contact Jerry Haas, retreat leader at *protected email*. Yes Special Diet RequestNoneVegetarianVeganGluten SensitivityOther - Fill in belowPlease let us know if you have any dietary issues.If other please name other diet requestTotal to Pay Now $0.00 Credit Card Card Details Cardholder Name CommentsThis field is for validation purposes and should be left unchanged.