2018 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 "noreply@ecatholicnotifications.com" 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 Mike Harrison to confirm your registration. Thanks!

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

Children's Names and Ages

Names and Ages of all children attending

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.

Lodging

Please arrange your own lodging.

We recommend that you use the group rate negotiated for the Best Western Hotel Benton Harbor / St. Joseph.

Best Western - Benton Harbor / St. Joseph
1592 Mall Drive
Benton Harbor, MI 49022

Reservations: (800) 780-7234,
Direct Phone: (269) 925-3000
Website: click here

Lodging Acknowledgment REQUIRED I acknowledge that I am responsible for my own lodging. Please fill out this field.

Lodging Room Sharing Please assist me in pairing up with another person to share the cost of a hotel room.

Lodging Comments

Financial Assistance for Registration/Housing/Travel REQUIRED I request financial assistance I do not need financial assistance I would like to donate extra to help others attend Please fill out this field.

Dollar Amount of Financial Assistance Requested Please enter valid data.

WE NEED YOU! Ways you can help.

We need everyone to pitch in and help (exceptions of course for physical limitations, parents of young children, etc).

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) 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