To register please print this form and mail along with your check or money order payable to:

Terrie McCallister

109 Jamar Drive

Natchitoches, LA 71457

August 7 - 9, 2009

$50.00 Deposit to reserve your spot

Directions can be found at:

http://www.crossroadsretreatcenter.com/

Scroll down to the bottom of the page for directions;

Questions e-mail Terrie at tchrter@hotmail.com or call me at 318-792-1201

Name: ________________________________________________

Address: ______________________________________________

City, State, Zip: ____________________________________________

Phone #_______________________________________________

Email: ________________________________________________

If you  have friends coming and want to share sleeping accommodations with them list their names here.

Names of Room-Mates: ________________________________________________________

______Please initial here that you have read and understand the Crop Cancellation Policy.

A confirmation letter will be sent upon receipt of your deposit.

 A $25.00 fee will be assessed for all returned checks.