Service Retreat Registration

Contact Name *
Contact Name
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Contact Phone *
Contact Phone
Leader's Cell Phone
Leader's Cell Phone
Organization/Group Address *
Organization/Group Address
Start Date
Start Date
End Date
End Date

By submitting this form, I understand that photographs may be taken of myself and members of my retreat group, regardless of age, and those photographs may be used by the news media, and/or in publications and materials to help promote Urban Immersion Service Retreats and/or the Greater Minneapolis Council of Churches.