Registration

Your Name (required)

Your Address (required)

Your Phone (required)

Your Email (required)

Which retreat do you wish to attend?

Would you like to purchase food service during your stay? (required)
YesNo

Arrival Date

Arrival Time

Departure Date

Departure Time

Emergency contact details (required)

Do you understand that a $50.00 non-refundable deposit is due within a week in order to reserve your room? (required)
Yes


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A $50.00 non-refundable deposit is required within ten days of registration to reserve a space. The total balance is due ten days before the event. Payment may be made through PayPal, cash, or checks made payable to Nazareth Retreat Center.

Having trouble with the digital form? Print this form instead and email it to us or send via postage: 

Nazareth Retreat Center
P.O. Box 7
Nazareth, KY 40048