***Please print this form and complete all entries. Then mail or Fax (charges only) with your deposit of $30.00 (or more) to the following address:
Our Lady of Florida Spiritual Center
1300 U.S. Highway #1
North Palm Beach, FL 33408
561-626-1300 - FAX 561-627-3956
RETREAT REGISTRATION FORM
**Please PRINT all information:
Name:_____________________________________________ Phone:(_____)__________________
Address_________________________________________________ City _____________________
State: ____ Zip: ________ Date of Birth:____/___/_____Cell:(____)_________________________
Parish or Group: _____________________________________ Date of Retreat:_________________
Retreat Type: Men _____ Women _____ Men & Women _____ Married _____ Other_____
E-Mail:_______________________________ Have you made a retreat here in the past? _________
Special Dietary or Other Requirements?__________________________________________________
__________________________________________________________________________________
Are You willing to share a room ( )Yes ( )No
I hereby authorize Our Lady of Florida Spiritual Center to charge my (check one):
VISA______MASTERCARD______ ACCOUNT NUMBER:_______________________________________
EXP. DATE (mm/yy)_______/_______ NAME ON CARD_______________________________________
SIGNATURE__________________________________________________
Amount to Charge:$___________________ PLEASE NOTE: If you are charging your expenses or paying by check, you may pay the registration fee ($30.00) or the total amount. If your credit card billing address is different from the above, please write it on a separate sheet of paper and include with your form. We will notify you to confirm your reservation.
Don't forget to include your deposit (or you may pay the full amount now).Thank you!!
WE WILL NOTIFY YOU TO CONFIRM YOUR RESERVATION