Registration Form | Ladies Conference

Name *

Phone Number *

Email address *

Address *

City *

Province *

Church Name *

Pastor's Name *

I will be bringing a nursing baby

Yes

Name of Baby and age

I would like to be billeted our for the nights (limited space available)

Yes

I have a serious food allergy (please list)

Waiver Release Form: I do hereby release Pembina Valley Baptist Church, Winkler, Manitoba and those acting on their behalf of all liability at the Ladies Retreat and any activities involved with the retreat from Thursday, October 22, through Saturday, October 24, 2026. Please print your name in the area below as your signature.

Please print your name here for the waiver release. *

I am signing up for: *

Early Bird for $160.00 (before October 4) and will make payment below.
Early Bird for $160.00 (before October 4) and I will send payment directly to the church.
Registration of $185.00 (after October 4) and I will make payment below.
Registration of $185.00 (after October 4) and I will send payment directly to the church.

Early Bird Registration (on or before October 4) CA$160.00 FREE shipping
Regular Registration Fee (after October 4) CA$185.00 FREE shipping