RETREATANT REGISTRATION FORM

“Come After Me” MT.4-19
Sts. Simon & Jude Catholic Parish
ACTS Men’s Retreat February 7-10, 2019

Participant Name *
Participant Name
Spouse First Name
Spouse First Name
Address *
Address
Cell Phone
Cell Phone
Work Phone
Work Phone
Home Phone
Home Phone
*
Will you have any specific dietary, mobility or medical needs during the weekend?
*
MEDICAL RELEASE AND LIABILITY WAIVER, EMERGENCY CONTACT INFORMATION:
Contact name *
Contact name
Contact Work Phone
Contact Work Phone
Contact Cell Phone
Contact Cell Phone
Signature
Date Signed *
Date Signed

To make a payment for the retreat, click on QUICK GIVE, choose a fund-ACTS RETREAT, next fill out your Credit Card information and Click Submit. Within a few seconds you will receive a confirmation. EASY, CONVIENIENT, SAFE.