Ladies' Retreat Registration Form
March 20 - 21, 2026
Alabama 4-H Center in Columbiana
Check-in begins at 2:00 on Friday. Dinner will be served at 6:00.
Name
*
Roommate Name
*
Email
*
This address will receive a confirmation email
Phone
*
Emergency contact name and phone number
*
Dietary needs
Please select all that apply.
Gluten free
Vegetarian
Other (contact Libby Gray)
Payment
Non-refundable deposit (30.00)
Double occupancy total (100.00)
Single occupancy total (150.00)
Non-refundable deposit (30.00)
Double occupancy total (100.00)
Single occupancy total (150.00)
Amount
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
Description
March 20 - 21, 2026
Alabama 4-H Center in Columbiana
Check-in begins at 2:00 on Friday. Dinner will be served at 6:00.
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