FALL RETREAT AT PURSELL FARMSOctober 13, 2025 to October 16, 2025 Name as on Drivers License/Government ID * First Name Last Name Company Name Job Title Email Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Birth Preferred Departure Airport Philadelphia Newark Baltimore Other- Please add name of airport in the comments section TSA Number if applicable Are you interested in fishing? Yes No Are you interested in ATV/UTV experience? Yes No Are you interested in golfing? Yes No If you are interested in golfing, would you need club rentals? NO YES- RIGHT HAND NO-LEFT HAND Do you have any food allergies or dietary restrictions? No Yes- Gluten Free Yes- I am vegan Yes-I am vegetarian Yes- Shellfish Allergy Yes- Dairy Allergy Yes- Nut (treenut and all nuts) Allergy Yes- Peanut allergy Yes- Dairy allergy Yes- other options not listed above. Please list any additional allergies in the comments section Comments Thank you!
