Online Registration Form

First Name:

Last Name:

Address:

City:

State:  Zipcode:

Phone # including area code:

Parish:

Email:

Are you a member of the Diocesan ECW Board?

Yes   No

Accommodations

Please choose one from list below:

Miller Commons- Single $150.00 Miller Commons - Double $106.00 (per person – min. of 2 per room) Stough Lodge - Single $150.00 Stough Lodge - Double $106.00 (per person – min. of 2 per room) Stough Lodge Dorm - $80.00 Scott House - $78.00 Cabins - $70.00

  For Double Accommodations:

    Name of Roommate:

I will need a handicapped-accessible room

Dietary restrictions (please specify in text box below):

Please type any further notes or instructions you need to communicate to Registration Team here:

Please click Submit once to Register. 

Don't forget to mail your payment

as soon as possible to:

Talma Delong

2603 Briar Cliff Rd.

Jasper, AL 35504