2018 EFC Irvine 30th Anniversary Retreat Registration Form (Registration Deadline: 8/19/18)
2018 EFCI 30th Anniversary Retreat
Date & Time: 9/1 Sat 2:30pm to 9/3 Mon 1:00pm
Theme: "Together in Unity, Abundance of Life" (Ephesians 4:12-13)
Speaker: Rev. Albert Lam
Site: University of California San Diego (UCSD)
Please fill out this form and select the appropriate payment amount then click submit.
Warning!
This form cannot be submitted until an administrator completes the setup process to receive online payments.
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Email
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Phone
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Address
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Fellowship or Small Group
Need financial assistance (if Yes do not use this on-line registration form, contact your congregation's Elder or Pastor for further information)?
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Please select one option.
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Total number of attendees
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Please select one option.
1
2
3
4
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6
Please provide all attendees' (including yourself) name, gender, age, grade, language, whether staying with parents (only age 12 and over), special needs info below (e.g. Joe Doe M 35 Taiwanese, Jan Doe F 33 Mandarin Handicap Housing, Jon Doe M 17 11th grade English Not staying with parents, Jen Doe F 10 4thgrade English Staying with parents):
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Need bus transportation ($20 round trip per person please select the appropriate payment amount)? ***If driving, no parking fee due to weekend and holiday.
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Please select all that apply.
Yes
No
Are you willing to volunteer as a helper for Children Ministry for 1 session
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Please select one option.
Yes
No
Payment amount (maximum per family cap for regular EFCI attendees: $440) **grandparents please register separately and cannot count towards family cap.
1 Regular EFCI attendee age 3 & older (110)
2 Regular EFCI attendees age 3 & older (220)
3 Regular EFCI attendees age 3 & older (330)
4 Regular EFCI attendees age 3 & older (440)
5 Regular EFCI attendees age 3 & older (440)
6 Regular EFCI attendees age 3 & older (440)
1 Non-regular EFCI attendee age 3 & older (180)
2 Non-regular EFCI attendees age 3 & older (360)
3 Non-regular EFCI attendees age 3 & older (540)
4 Non-regular EFCI attendees age 3 & older (720)
5 Non-regular EFCI attendees age 3 & older (900)
6 Non-regular EFCI attendees age 3 & older ($1080)
1 Regular EFCI attendee age 3 & older with bus ($130)
2 Regular EFCI attendee age 3 & older on or before 8/5 with bus (260)
3 Regular EFCI attendee age 3 & older on or before 8/5 with bus (390)
4 Regular EFCI attendee age 3 & older on or before 8/5 with bus (520)
5 Regular EFCI attendee age 3 & older on or before 8/5 with bus (540)
6 Regular EFCI attendee age 3 & older on or before 8/5 with bus (560)
1 Non-regular EFCI attendee age 3 & older with bus ($200)
2 Non-regular EFCI attendee age 3 & older with bus (400)
3 Non-regular EFCI attendee age 3 & older with bus (600)
4 Non-regular EFCI attendee age 3 & older with bus (800)
5 Non-regular EFCI attendee age 3 & older with bus (1000)
6 Non-regular EFCI attendee age 3 & older with bus (1200)
1 Regular EFCI attendee age 3 & older (110)
2 Regular EFCI attendees age 3 & older (220)
3 Regular EFCI attendees age 3 & older (330)
4 Regular EFCI attendees age 3 & older (440)
5 Regular EFCI attendees age 3 & older (440)
6 Regular EFCI attendees age 3 & older (440)
1 Non-regular EFCI attendee age 3 & older (180)
2 Non-regular EFCI attendees age 3 & older (360)
3 Non-regular EFCI attendees age 3 & older (540)
4 Non-regular EFCI attendees age 3 & older (720)
5 Non-regular EFCI attendees age 3 & older (900)
6 Non-regular EFCI attendees age 3 & older ($1080)
1 Regular EFCI attendee age 3 & older with bus ($130)
2 Regular EFCI attendee age 3 & older on or before 8/5 with bus (260)
3 Regular EFCI attendee age 3 & older on or before 8/5 with bus (390)
4 Regular EFCI attendee age 3 & older on or before 8/5 with bus (520)
5 Regular EFCI attendee age 3 & older on or before 8/5 with bus (540)
6 Regular EFCI attendee age 3 & older on or before 8/5 with bus (560)
1 Non-regular EFCI attendee age 3 & older with bus ($200)
2 Non-regular EFCI attendee age 3 & older with bus (400)
3 Non-regular EFCI attendee age 3 & older with bus (600)
4 Non-regular EFCI attendee age 3 & older with bus (800)
5 Non-regular EFCI attendee age 3 & older with bus (1000)
6 Non-regular EFCI attendee age 3 & older with bus (1200)
Amount
If any attendee(s) are under the age of 18 please have parent/guardian read below statement, print name, date & provide emergency contact number below: I authorize the applicant(s) named to attend the 2018 30th Anniversary Retreat with Evengelical Formosan Church of Irvine (EFCI). I give EFCI and its agents permission to authorize medical care rendered by any physician licensed under the Medical Practice Act. I authorize any hospital which has provided treatment to surrender physical custody of the applicant(s) to EFCI upon completion of treatment. I release EFCI and its agents from all legal and financial liabilities. I further agree to that EFCI, UCSD and both their agents be free from any legal or finacial obligations that may arise or be caused in any way by use of the facilities, properties or involvment during the Retreat from September 1 to September 3, 2018, pursuant of California Civil Code, Sect. 25. 8.
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By checking the box below I agree to be subject to all rules and regulations of the Retreat and UCSD, and to fully cooperate with the Retreat administrators during the Retreat
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Please select all that apply.
Yes
Emergency Contact (Name/Phone No.)
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Additional Info & Comments
Upload paper version retreat registration form if available
Upload (8MB)
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
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AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
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WY
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Submit
Description
2018 EFCI 30th Anniversary Retreat
Date & Time: 9/1 Sat 2:30pm to 9/3 Mon 1:00pm
Theme: "Together in Unity, Abundance of Life" (Ephesians 4:12-13)
Speaker: Rev. Albert Lam
Site: University of California San Diego (UCSD)
Please fill out this form and select the appropriate payment amount then click submit.
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