Form-Individual Request

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Type of Retreat *

Individual Couple Family

Number of People *

Number of Beds *

Requested Dates of Stay *

Lodging Preference *

Meeting Room Request *

Are you a member of a WPA United Methodist Church? *

Yes. No.

Our Food Service Director is happy to plan the menus for each day of your visit. If you would prefer to select your menus, options will be send to you. *

Please plan menus for me. Please send menu options. No food service necessary.

A deposit of First Night Rate is required to reserve dates. Please reach out to our reservations office with questions. I will send my deposit by: *

Cash/Check (mail to PO Box 8, Ludlow, PA 16333) Credit/Debit Card (call 814-945-6512)

List any accessibility or dietary concerns: *

List any additional requests: *

Individual or Family Retreat Reservation