Retreat General Registration Form

Name:    
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   $160.00 

Double  $130.00   Roommate (name)

Week

Directed $380.00
     
Do you have any special needs? (Check all that apply) Dietary  Access  Other
If so, please explain:


In order for us to reserve your place for the retreat, you must send a non-refundable deposit of $75 made payable to
Our Lady Queen of Peace Retreat Center.

Please mail to:
Our Lady Queen of Peace Retreat Center
3630 Dancyville Road
Stanton, TN  38069-4711