Directed Retreat Registration Form

Name:  First / Middle / Last
Address:
City:  State: ZIP:  
     
Home Phone:    () 
Office Phone:    () 
Email: 
Occupation/Ministry:
Date of Birth: //
Name of Parish:    City/Town of Parish:
Emergency Contact:     Phone Number: ()
     
Check all that apply:

Religious Sister  Yes  No
Religious Brother  Yes  No
Permanent Deacon  Yes  No
Priest  Yes  No
Seminarian  Yes  No
Lay Person  Yes  No

Is this your first directed retreat?  Yes  No
     

Retreat Date:       June 20-26, 2010                 July 16-22, 2010               July 25-31 

Retreat Type:

Directed $390.00 (Full)    Directed $65.00/Day (Partial)

I will be paying by:

     
PLEASE COMPLETE THE FOLLOWING QUESTIONS

(Your brief responses will be helpful in selecting a director and for the benefit of your director. All information will remain confidential)

1. List your retreat experience for the past 3-4 years (e.g. directed, guided, weekends, etc. with location and year).

2. If you have a spiritual director, how often do you visit?

3. How have your most recent retreats impacted your life?

4. How comfortable are you with maintaining silence during your retreat?

5. List any health or special needs you may have.

 

RESERVATION / RETREAT OFFERING PAYMENT INFORMATION

In order for us to reserve your place for the retreat, you must make a non-refundable deposit of $75.
You may also make a complete retreat offering instead [includes deposit].

Mail a check made payable to: Our Lady Queen of Peace Retreat Center
3630 Dancyville Road, Stanton, TN  38069-4711 • 731-548-2500

- or -

You may pay your reservation deposit or retreat offering online.


The Catholic Diocese of Memphis uses the secure online payment services of PayPal.
You may use your PayPal account or a major credit card.