Confirmation Form

Leaders Name:

Phone Number:                                    Email:

Group Name:


City:                                          State:                   Zip:

Arrival Date:

Departure Date:

              $100 Retreat Package (2 Nights Stay, 5 Meals & 1 Evening Arrival Snack)

      $55 Lodging and Meals per person per day

              $28 Lodging Only per person per day

              $18 Day use Fee per person per day

Please Indicate your Choices:

                Pizza snack on arrival night. (Included in Retreat  Package)

                 Dinner on Arrival ($ 9.00 extra per person)

If your group plans an off premise activity, please indicate the following:

Bag Lunch needed                    Activity Date:

I have read the rate sheet and will familiarize my group with its contents and agree to abide by its terms.  I understand that the dates of my retreat will not be held without the required deposit.

Shiloh Retreat Lodge
Established. 1980
Shiloh's Devotional Program and Activities.
We will provide our Own Speaker and Activities.