Women&#039;s ACTS &lt;div&gt;Retreat Registration&lt;/div&gt;

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2023 Women's ACTS Retreat
April 27 ^th - 30 ^th, 2023
Participant Information:
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. 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.
- Mobile Phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Home Phone Number Maximum 20 characters Please enter a phone number.
- Work Phone Number Maximum 20 characters Please enter a phone number.
- E-mail REQUIRED Please fill out this field. Please enter an email address.
- Birth Date REQUIRED Please fill out this field. Please enter a date.
- Marital Status (Please select one) REQUIRED Married Single Widowed Please fill out this field.
Spouse (or Friend) Contact Information:
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Emergency Contact Yes
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Have you ever attended an ACTS Retreat? REQUIRED Yes No Please fill out this field.
If yes, when and where? Please enter valid data.
Did someone invite you to this retreat? REQUIRED Yes No Please fill out this field.
If yes, who invited you? Please enter valid data.
About Your Parish/Church:
- Parish or church you attend: REQUIRED Please fill out this field. Please enter valid data.
- City: REQUIRED Please fill out this field. Please enter valid data.
- Religion/Denomination: REQUIRED Please fill out this field. Please enter valid data.
- How many persons can we call to pray for you: REQUIRED Please fill out this field.
- Prayer contact (not attending retreat) 1
  - First Name Please enter valid data.
    
    Last Name Please enter valid data.
  - Emergency Contact Yes
  - Phone Number Maximum 20 characters Please enter a phone number.
- Prayer contact (not attending retreat) 2
  - First Name Please enter valid data.
    
    Last Name Please enter valid data.
  - Emergency Contact Yes
  - Phone Number Maximum 20 characters Please enter a phone number.
- Prayer contact (not attending retreat) 3
  - First Name Please enter valid data.
    
    Last Name Please enter valid data.
  - Emergency Contact Yes
  - Phone Number Maximum 20 characters Please enter a phone number.
Accommodation Needs:
- Special Needs? REQUIRED
  Do you have any specific dietary, medical, and/or physical needs for the weekend?
  Yes No Please fill out this field.
- Medical:
- Ambulatory/Physical:
- Dietary:
- Food Allergies:
***** Please be advised *****

There is a registration fee of $300 to offset costs associated with the retreat. An initial non-refundable deposit of $100 must be received on or prior to the 4:30 p.m. Mass held on February 26, 2023, along with completed forms. Any outstanding balance must be received on or prior to April 3, 2023.

Please make payment via check, payable to St. Faustina Catholic Church. And please notate "ACTS" on the document.

As the costs may pose a financial hardship for some, please know that limited financial assistance may become available, therefore those in need should not be dissuaded from seeking to attend.

I understand the deadlines and financial obligations identified above. Please select this field.
A registration fee of $300 is required to offset costs. REQUIRED I will pay in full on or prior to February 26, 2023 I will pay in full through installments on or prior to April 3, 2023 I will need financial assistance Please fill out this field.

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Women's ACTS Retreat Registration

2023 Women's ACTS Retreat

Women's ACTS
Retreat Registration