Anchor Retreat 2023

Note: If you are considering applying for a scholarship, please do not register until after you have received your award.

If you have questions or concerns about the retreat, please contact us at [email protected]

Registrant Information

Name*

Preferred First Name*

Email*

Confirm Email*

Yes, please send me updates and opportunities related to InterVarsity’s ministry.

Phone Number*

May we text you at this number for event related updates, onsite emergencies, etc.?*

Country*

Address*

City, State and ZIP Code*

Date of Birth*

Gender*

Male
Female
Prefer Not To Identify

Ethnic Identification (check all that apply):*

Black/African American
East Asian American
Hispanic/Latino American
Middle Eastern American
Native American/Alaska Native/First Nations
Native Hawaiian/Polynesian/Melanesian/Micronesian
South Asian American
Southeast Asian American (Including Filipino)
White/Caucasian American
Bi-Racial/Multi-Racial (Include any counted in the other ethnic categories)
International
Prefer Not To Identify

Accommodations Details

Shared Bed Acknowledgement*

I am aware that I may be sharing a bed with another same gender attendee.
We will make every effort to provide individual beds but some rooms have queen or king beds that may be shared with a same gender bed mate.
I am married and bringing my spouse. My spouse will register separately.
Please provide name of spouse below. We will provide one queen or king bed as available. Each spouse is required to register for the conference separately.

Name of Spouse (optional)

Emergency Contact Information

Emergency Contact Name*

Emergency Contact Phone*

Emergency Contact Relationship*

Medical Insurance: Are you covered by a Medical Insurance policy?*

College / University Information

MBA College/University

Other MBA Program? Please specify:

Year of Graduation from MBA Program*

How did you hear about the Anchor Retreat?*

If there was an individual, please specify

Do you require any physical accommodations or have any dietary restrictions?*

Other Requirements/Restrictions

Would you be interested in helping on the planning team for Anchor Retreat 2024*

What do you hope to get from your Anchor Retreat experience?*

Individual Release/Waiver

Should the PDF not display properly, you may download a copy of the Individual Release-Waiver_10.22.2020.pdf

Individual Release/Waiver | Version 10.22.2020*

I have read and agree to the terms above.

Registration Type

Registration Options*

MBA Student ($225.00)

Sub Total

$0.00

Total

$0.00

Coupon Code

Billing Information

Name on Card*

Use a previously saved card

Card Number*

Visa
Mastercard
Discover

Expiration Date*

Save this card for future use

Country*

Address*

City, State and ZIP Code*

Email*

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