Online Retreat Registration Form
(May 9-13, 2018)


Name:*(*Required)

Address:*

City:* State:* Zip:

Email:*

Telephone:*

Emergency Contact(name+telephone):*


RESERVATIONS: Please mark the appropriate options:

Wednesday-Sunday
Single: $370.00
Double: $340.00

Roommate preference:

Per Diem: (Daily room and 3 meals)

$100.00/each day, Please indicate dates:

I need accomodation for disability (please specify):
I am requesting vegetarian meals.
Any Special Requests?

I hereby release and indemnify the Mercy of God Community and the retreat center from any and all claims arising from my attendance at this gathering.
Policies: If the registration is canceled and the community is charged, no refund; if it is canceled and we are not charged, a refund less $100.00 fee, only if there are excess retreat funds available. Late registration: no guarantees.


Signed (type name) *Dated:*

Travel details:




Thanks for registering online for the retreat!

www.000webhost.com