Bellarmine Jesuit Retreat House · September 27- 29, 2024 (Co-Ed Retreat)

Name *

Prefix

First Name

Last Name

Suffix

How would you like your name to appear on your name tag and materials? *

Email *

Verify Email *

Cell Phone *

I would like a text reminder about this retreat. *

Landline (optional)

Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Birth Date *

To assist with room assignments, please enter your birthdate. (mm/dd/yyyy)

Gender *

To assist with room assignments, please enter your gender.

Please select ONE retreat contribution option.

Retreat Contributions *	Quantity
$100 - Non-refundable Deposit per Retreatant
$365 - Total Suggested Contribution per Retreatant

You have selected two options under Retreat Contributions. Please select only one option to proceed. Thank you.

I want to make an additional donation:

$

Emergency Contact Name *

Emergency Contact Relationship *

Emergency Contact Phone Number *

Are you part of a parish/church? *

Enter parish/church name *

Are you part of a retreat group? *

Enter group name *

Do you have a room request based on medical needs? *

Yes

No

Please provide brief reason for room request, e.g. CPAP machine, limited mobility, etc. *

Bathrooms are assigned based on age or medical needs. Only 20% of our rooms have ensuite bathrooms.

Have you attended a Bellarmine weekend retreat in the past three years? *

Yes

No

Do you want to be in the *

Do you want to participate in small group sharing sessions? *

Do you have any dietary restrictions? *

You are welcome to bring your own food. A refrigerator and microwave are available for your use.

None

Vegan

Vegetarian

Gluten free

Dairy free

Other

Other - Please enter information regarding any other food allergies. *

If the main retreat house building is fully occupied, are you willing to stay in our rustic cottage or coachhouse? *

Cottage

Coachhouse

No

If the main retreat house building is fully occupied, are you willing to stay in our rustic cottage? *

Cottage

No

Retreat Registrant 2

Registrant 2 Name *

Prefix

First Name

Last Name

Suffix

Registrant 2 Email *

Please enter the email address of this guest. Please do not re-enter your email address.

Verify Email *

Registrant 2 Cell Phone *

Retreat Registrant 3

Registrant 3 Name *

Prefix

First Name

Last Name

Suffix

Registrant 3 Email *

Please enter the email address of this guest. Please do not re-enter your email address.

Verify Email *

Registrant 3 Cell Phone *

Retreat Registrant 4

Registrant 4 Name *

Prefix

First Name

Last Name

Suffix

Registrant 4 Email *

Please enter the email address of this guest. Please do not re-enter your email address.

Verify Email *

Registrant 4 Cell Phone *

Semi Silent Retreat Registration

September 27- 29, 2024
Charismatic Retreat: "I Will Send You Another Advocate"
Co-Ed Retreat

Retreat Leader - Fr. Michael Sparough, SJ

Retreat Registrant 2

Retreat Registrant 3

Retreat Registrant 4

Payment Information

Semi Silent Retreat Registration

September 27- 29, 2024Charismatic Retreat: "I Will Send You Another Advocate"Co-Ed Retreat

Retreat Leader - Fr. Michael Sparough, SJ

Retreat Registrant 2

Retreat Registrant 3

Retreat Registrant 4

Payment Information

September 27- 29, 2024
Charismatic Retreat: "I Will Send You Another Advocate"
Co-Ed Retreat