A MOMENT OF TIME IN ETERNITY

A Moment of Time in Eternity Jan 25-27, 2019 Registration Form
*Name:
*Age Group:
*Gender: Male Female
*Maritial Status: Single Married Others
*Tel: (Home)
(Office)
(H/P)
Address:
*Email:
Local Church Name:
Christian Since: (Year)
Comments/ Remarks:
I am new to/familiar with contemplative/quiet retreats
Contribution: RM350 per person
Enquiries: Please email icm@trac.org.my (or call 03-7954 2836)
Please respond to the following questions:
1.Preferred room-mate (if applicable)
*Verification Code: