Registration

Your Name (required)

Your Address (required)

Your Phone (required)

Your Email (required)

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Which retreat/s do you wish to attend?

Arrival Time

Departure Time

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Emergency contact details (required)

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

Print and mail this form or complete below.