2022 NC Regional Gathering Registration

Please fill out all the information below, then press the Submit button at the bottom of the page.

You will receive an email from sender "[email protected]" with confirmation of your registration (check your Spam/Trash folder if you don't see the confirmation).

If you don't receive an email confirmation, please contact ??? to confirm your registration. Thanks!

Name (Individual or Couple) REQUIRED Please fill out this field.

Childrens' Names

Names of nursing children attending with you.

Email REQUIRED Please fill out this field. Please enter an email address.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

City/State REQUIRED Please fill out this field. Please enter valid data.

Transportation REQUIRED Please fill out this field.

Arrival and/or Departure times ONLY if different than Gathering beginning/end times

Special Needs (e.g. Dietary Restrictions, Handicap Access, etc. Specify "None" if not applicable) REQUIRED Please fill out this field.

Housing REQUIRED I wish to stay at the Retreat Center I wish to stay at the local Hampton Inn (primarily for couples or others special circumstances) I will make my own housing arrangements apart the options above, at my own expense (unusual circumstances) Please fill out this field.

Housing Comments

Staying for Sunday Lunch at Noon? REQUIRED

We need an accruate count, as some folks leave early.

Yes No Please fill out this field.

WE NEED YOU! Ways you can help.

If this is registration for a couple, please have each person complete their own set of "ways to help" options. Otherwise, individuals please use the "Adult 1" forms only.

Name of Adult 1 (if this is registration as a couple) REQUIRED Please fill out this field. Please enter valid data.

Adult 1 - Other Help I Can Offer Please enter valid data.

Name of Adult 2 (if this is registration as a couple) Please enter valid data.

Adult 2 - Other Help I Can Offer Please enter valid data.

Additional Comments