Miramar Retreat Center - Directed Retreat Reservation Form

Miramar Retreat Center
DIRECTED RETREATS
RESERVATION and PAYMENT Forms

IMPORTANT: ALL INFO MUST BE FILLED IN

Requested Retreat Date: (mm/dd/yyyy) (REQUIRED)

Would you like to be placed on a waiting list if the retreat is full?
Yes
No

Is this a New Address: Yes No

Birth Year: (yyyy)

Name: (Required)

Address:(Required)

City:(Required)

State:(Required)

Zip: (Required)

Telephone: (Required)

Cell Phone:

Email: (Required)

Religious: Yes No

Married: Yes No

Priest: Yes No

Number of Years:

Single: Yes No

Congregation:

Do You need a first floor room? Yes: No:

Emergency Contact: (Required)

Telephone:(Required)

Do you have a preference for a director? Yes: No: Male: Female:
(We cannot guarantee we will fulfill your preference, but we will do our best).

Have you made a directed retreat before?
Yes: No:

How Recently:

Are you presently in spiritual direction? Yes: No:

If no, have you ever been in spiritual direction? Yes No

Recent living conditions:

Current work ministry:

Health Needs:

Reasons/goals for making retreat:

1. MAKE YOUR SELECTIONS.

2. SUBMIT YOUR RESERVATIONS.

3. MAKE YOUR PAYMENT.

2012 DIRECTED RETREATS

June 24 - July 1, 2012 - 7 - Day Directed Retreat

July 15 - 22, 2012 - 7 - Day Directed Retreat

August 5 - 12, 2012 - 7 - Day Directed Retreat

SUBMIT RESERVATION:
( Please click Submit Reservation NOW BEFORE making payment below.)

PAYMENT FORM Click on shopping cart. Payment page will open in a new window. Add item to basket. To make changes click on "basket contents" first. Then click on "checkout".
June 24 - July 1, 2012 - 7 - Day Directed Retreat
- $100.00 Deposit	- $500.00 Full Payment
July 15 - 22, 2012 - 7 - Day Directed Retreat
- $100.00 Deposit	- $500.00 Full Payment
August 5 - 12, 2012 - 7 - Day Directed Retreat
- $100.00 Deposit	- $500.00 Full Payment

If your application and deposit have been received and rooms are still available, we will make a reservation.
Otherwise, we will contact you to consider another date or your payment will be refunded.

FOR MORE INFORMATION
CALL: (781) 585-2460
FAX: (781) 585-3770
E-MAIL: miramarma@aol.com

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