Women’s Retreat Application – Saint Andrew Parish

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 State ZIP Code

Email(Required)

Enter Email Confirm Email

Primary Phone(Required)

Secondary Phone

Marital Status(Required)

Religion?(Required)

Parish?

Occupation(Required)

Date of Birth(Required)

Emergency Contact Information

Emergency Contact Name:(Required)

First Last

Relationship:(Required)

Primary Phone(Required)

Secondary Phone

Additional Questions

I heard about Emmaus from:

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)

Retreat will be held at St. Andrew Catholic Church, 9950 N.W. 29th St., Coral Springs – Transportation is provided RETREAT STARTS: Friday, September 29th at 5:30 pm with a Meet & Greet at St. Andrew Social Hall RETREAT ENDS: Sunday, October 1st at 3:00 pm with a Wrap Up at St. Andrew Social Hall COST: $150.00 – Includes all meals, lodging, and transportation. A non-refundable $25 Deposit is required with the application.

Payment Information

Non-Refundable Deposit(Required)

Deposit - $25.00
Full Payment - $150.00

Processing and Service Fees(Required)

A 3% Processing and Service Fee has been added.

Price: $0.00

Amount Due:

$0.00

Billing E-mail Address:(Required)

Enter Email Confirm Email

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Womens Emmaus Retreat

Emergency Contact Information

Additional Questions

Payment Information