Women’s Retreat Application Womens Emmaus Retreat 2026 July 31 - August 2, 2026 Be good to yourself... YOU DESERVE IT!! Take a break from your daily routine and renew your faith. Get away for a weekend, walk with the Lord, to be still and allow Him to reveal Himself to you. Name(Required) First Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email(Required) Enter Email Confirm Email Primary Phone(Required)Secondary PhoneMarital Status(Required) Single Engaged Married Divorced Widowed Religion?(Required)Parish?Occupation(Required)Date of Birth(Required) Month Day Year Emergency Contact InformationEmergency Contact Name:(Required) First Last Relationship:(Required)Primary Phone(Required)Secondary PhoneAdditional QuestionsI heard about Emmaus from:Primary Language Spoken?(Required)Other Languages Spoken?Do you know anyone coming to this Emmaus?(Required) Yes No If so, who?Please provide any dietary restrictions, allergies, or physical limitations that we should be aware of:Do you smoke?(Required) Yes No Polo Shirt Size(Required) Small Medium Large X-Large XX-Large Retreat will be held at St. Andrew Catholic Church, 9950 N.W. 29th St., Coral Springs – Transportation is provided RETREAT STARTS: Friday, July 31st at 6:00 pm with a Meet & Greet at St. Andrew Social Hall RETREAT ENDS: Sunday, August 2nd at 3:00 pm with a Wrap Up at St. Andrew Social Hall COST: $175.00 – Includes all meals, lodging, and transportation. A non-refundable $25 Deposit is required with the application. Payment InformationNon-Refundable Deposit(Required) Deposit - $25.00 Full Payment - $175.00 Amount Due: Billing E-mail Address:(Required) Enter Email Confirm Email Billing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Credit Card(Required) American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Security Code Cardholder Name