AQN Fall Retreat Registration & Payment Deadline: August 20, 2021 "*" indicates required fields Name* First Last Phone*Email* City* Meal ChoicesMonday Dinner: Agapé Mediterranean Buffet*$20. The buffet includes Rice Bowls, Salads, choice of chicken or vegetarian with two sauces, five topping spreads, two dips with pita chips and a baklava tray for dessert. Please choose your preference for Chicken or Vegetarian. Chicken ($20) Vegetarian ($20) I will not be attending dinner Tuesday Lunch*Please let us know if you will be ordering lunch on Tuesday from Panera Bread. Yes ($13) No Panera Lunch Choice*Please visit Panera Bread's boxed lunches menu (link will open in a new tab). You may choose from Sandwich Box Lunch; Salad Box Lunch; Half Sandwich, or half salad Box Lunch. EACH box lunch includes a cookie. Sandwiches are all cold and have pickles with chips or optional apple. Salads come with a whole grain baguette. Half & half you must indicate the sandwich & salad you want. Click on Description under the box lunch you want to order to see what the meal contains. We will furnish the drinks. ***Please write below which box lunch you would like and any special requests (for example apples instead of chips and half & half details) so we can order your lunch.Tuesday Dinner*$18. Chinese - please indicate at the bottom of this form your dietary needs. We will be making the selections for these dinners based on this information. I will be attending dinner ($18) I will not be attending dinner No Wednesday Lunch: Lunch is on your own at local restaurants in small groups prior to afternoon activities.Wednesday Dinner*$15. Pizza & salad - please indicate at the bottom of this form your dietary needs. We will be making the selections for these dinners based on this information. I will be attending dinner ($15) I will not be attending dinner Dietary NeedsPlease indicate any dietary needs. Vegetarian Vegan Fish No Fish Food Allergies Please list any allergies or food requests here:Retreat CheckoutRetreat Registration Fee* Price: Total Payment Option* Check PayPal Please hit the submit button to submit your form. Once you submit your form, you will receive a confirmation message and information on where to mail your check. We look forward to seeing you!Please hit the submit button below and you will be redirected to the PayPal website to complete payment. NameThis field is for validation purposes and should be left unchanged.