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Women's Retreats

- REGISTER BELOW!
- REGISTRATION
  
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  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parish & City Please enter valid data.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Cell Phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Work Phone Maximum 20 characters Please enter a phone number.
  
  Home Phone Maximum 20 characters Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Birth Date (optional) Please enter valid data.
  
  EMERGENCY CONTACT #1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship REQUIRED Please fill out this field. Please enter valid data.
  
  Cell Phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Work Phone Maximum 20 characters Please enter a phone number.
  
  Home Phone Maximum 20 characters Please enter a phone number.
  
  EMERGENCY CONTACT #2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship REQUIRED Please fill out this field. Please enter valid data.
  
  Cell Phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Work Phone Maximum 20 characters Please enter a phone number.
  
  Home Phone Maximum 20 characters Please enter a phone number.
  
  Do you have any special dietary needs? REQUIRED Yes No Please fill out this field.
  
  If yes, please specify needs
  
  Do you have any mobility problems such as difficulty climbing stairs, use a cane, walker, or wheel chair? REQUIRED Yes No Please fill out this field.
  
  If yes, please specify (mobility challenges should NOT deter you from attending)
  
  Roommate Name (if applicable) Please enter valid data.
  
  Registration Fee 299.0 – Single room 249.0 – Double room 219.0 – Triple room (must register same day)
  
  Note: full refund if canceling prior to August 31. If cancelling after August 31, and prior to September 30, refund available less a $75 cancellation fee. Refunds unavailable after September 30, but may be transferred to another registrant. Full credit given for a future retreat to be used within one year if cancelling due to health and/or family emergencies.
  
  If you would like to make a donation to this ministry, please indicate the amount. Thank you! $ Please enter a positive decimal.
  
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