Registration Form | Ladies Conference 2025

Name *

Phone Number *

Email address *

Address *

City *

Province *

Church Name *

Pastor's Name *

I will be bringing a nursing baby *

Yes

Name of Baby and age

I would like to be billeted our for the nights (limited space available)

Yes

I have a serious food allergy (please list)

Waiver Release Form: I do hereby release Pembina Valley Baptist Church, Winkler, Manitoba and those acting on their behalf of all liability at the Ladies Retreat and any activities involved with the retreat from Thursday, October 23, through Saturday, October 25, 2025. Please print your name in the area below as your signature.

Please print your name here for the waiver release. *

I am signing up for: *

Early Bird for 150.00 (before October 5)
Registration of $175.00 (after October 5)

Please make your payment below.

Send me a copy

Early Bird Registration (on or before October 5) CA$150.00
Regular Registration Fee (After October 5) CA$175.00