General Retreat Registration Form

Name: [Enter Husband/Wife Name If Married Couple]
Address:
City:  State: ZIP:  
     
Home Phone:    () 
Office Phone:    () 
Email:  
Occupation:
Date of Birth: //
Name of Parish:    City/Town of Parish:
Emergency Contact:     Phone Number: ()
     
Have you ever made a retreat with the Passionist Sisters of Memphis?  Yes  No
     
Name of the particular retreat you are registering for:

Date of this retreat:

Rooms at the Retreat Center are single or double occupancy.

Retreat Offering:

Weekend

Single   $170.00 

Double  $140.00/Person   Roommate (name)

Married Couple: $265.00

Week

Directed $390.00

I will be paying by:

     
Do you have any special needs? (Check all that apply) Dietary  Access  Other
If so, please explain:

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.