Ph: (217) 498-6771
(309) 662-7380

Booking Request For The Retreat Center!

Requester's First Name*

Requester's Last Name*

Requester's Phone Number*

Requester's Email (Optional)

Fun Group Name (Optional)

Number of Attendees*

Start Date Requested (exp. 01/01/2019)*

End Date Requested (exp. 01/03/2019)

Attendee 1: First & Last Name; Email

Attendee 2: First & Last Name; Email

Attendee 3: First & Last Name; Email

Attendee 4: First & Last Name; Email

Attendee 5: First & Last Name; Email

Attendee 6: First & Last Name; Email

Attendee 7: First & Last Name; Email

Attendee 8: First & Last Name; Email

Have you added all the attendees names and emails? If so, please check the box. *

Is there anything you would like to add before submitting your request?

| | | | | | | | |

And additionally, paste this code immediately after the opening tag: