Men’s Retreat 2025 Registration Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.This form must be completed by all participants in overnight activities, field trips, events requiring group transportation, and any other event sponsored by Medhane-Alem Evangelical ChurchRetreat InformationMen’s Retreat 2025 Location of Retreat: Camp Ghormley 640 Lost Lake Road Naches, WA 98937 Dates of Retreat: Thursday, August 28th – Saturday, August 30th, 2025 Participant InformationName *FirstLast phone and Name Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone *Email *T-Shirt Size *XLLMSRelease of Liability and Medical Emergency AuthorizationAlthough M.A.E.C. and its representatives will take every precaution to safeguard the health and well-being of the above-named participant and to prevent accidents, I release them from any liability in the event of illness or injury resulting from this activity. Furthermore, I release the owner and driver of the vehicle transporting the above-named participant to and from the event from any liability in the event of illness or injury. In the case of sudden illness or an accident requiring immediate treatment or surgery while the above-named participant is involved in this activity, I authorize the M.A.E.C. minister(s) to take any action deemed necessary to protect the participant’s health and physical well-being. This authority extends to any physician(s) and/or surgeon(s) selected by the M.A.E.C. minister(s) to perform medical or surgical procedures, including examinations and tests necessary to preserve the participant’s health and physical well-being. Every effort will be made to contact the emergency contact persons listed below in the event of an emergency.Name of primary emergency contact *FirstLastEmergency contact phone number *Name of additional emergency contactFirstLastAdditional emergency contact phone numberParticipant's Signature * Clear Signature Comment or MessageSubmit
