Miramar Retreat Center - Directed Retreat Reservation Form

Miramar Retreat Center Directed Retreat Reservation Form
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:
Address:
City:
State:
Zip:
Telephone:
Cell Phone:
Email:
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:
Telephone:
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. SUBMIT RESERVATION form: (Click Submit Reservation Button Below)
2009 DIRECTED RETREATS

January 2-9, 2009 ( 7 nights) May 17-22, 2009 ( 5 nights) June 21-28, 2009 ( 7 nights) July 12-19, 2009 ( 7 nights) August 2-9, 2009 ( 7 nights)

( Please click Submit Reservation NOW before making payment below.)

2. MAKE PAYMENT: 7 - NIGHT DIRECTED RETREAT (Payment links open in new window) Full Payment Cost: $455.00 Make Full Payment Now Non Refundable Deposit $100.00 Make Non-Refundable Deposit Now 2. MAKE PAYMENT: 5 - NIGHT DIRECTED RETREAT (Payment links open in new window) Full Payment Cost: $325.00 Make Full Payment Now Non Refundable Deposit $75.00 Make Non-Refundable Deposit Now

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 RETURN TO MIRAMAR HOMEPAGE