St. Vincent de Paul Parish

we are a Catholic community rooted in the Eucharist
and committed to the poor

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2017 Retreat Registration

- Social Happenings

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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.
- 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.
- Home Phone Number Please enter a phone number.
- Cell Phone Number Please enter a phone number.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Emergency Contact:
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Relationship REQUIRED Please fill out this field. Please enter valid data.
- Single rooms will be avaliable on a first come first serve basis.
- Roomate option: REQUIRED I would prefer a single I would like to room with: Please fill out this field.
- roomate Please enter valid data.
- Fee Includes
  
  Dinner Friday, Breakfast, Lunch and Dinner Saturday and Breakfast Sunday
  
  2 night accomodation single/double
- Fee$215.0
Total: $

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