Name of Group:___________________________
Mailing Address:_________________________
City ______________________ State _____ ZIP____________
Contact Person:____________________________
Phone:____________________________
Church:__________________________________
Pastor:___________________________________
Choice of Dates (1)_______________________
Choice of Dates (2)_______________________
(Please allow a 2 week notice)
To secure date requested, send a $25.00 nonrefundable check made payable to
“Fraser Road Church of God” to:
RETREAT CENTER RESERVATIONS
c/o Mike Pilon
1712 Michigan
Bay City, MI 48708
