New Candidate Registration

All fields are required. Please make sure each question has some type of response. Thank you.

First Name

Last Name

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Address:

City:

State:

Zip:

Phone

E-mail

Date of Birth

Age

Gender

Religion

Name of Parish

Name of Pastor

Select the event you'd like to attend:

CMK #224 : Koinonia Feb 25 - 27, 2022

Name that you would like on your name tag.

What is your current participation in your church?

Have you had any previous retreat experiences and if so, describe briefly.

What do you expect from Koinonia?

How did you find out about Koinonia? Specific names are helpful.

If you have any food or other allergies, please list them here. If none, please enter none.

Please indicate any dietary or special health requirements we should know about to make your weekend more comfortable. If none, please enter none.