Miramar Retreat Center SPECIAL RETREATS RESERVATION and PAYMENT Forms

IMPORTANT: ALL INFO MUST BE FILLED IN

Enter Retreat Date: (Required)(mm/dd/yyyy)

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

Is this a New Address? Yes   No

Name: (Required)

Address: (Required)

City: (Required)

State: (Required)

Zip: (Required)

Telephone: (Required)

Cell Phone:

Email: (Required)

Single Room:  (Please select one)  Yes  No

Do You Need a First Floor Room?  Yes:  No:

Name of Emergency Contact: (Required)

Emergency Contact Telephone: (Required)

1. MAKE YOUR SELECTIONS. 2. SUBMIT YOUR RESERVATIONS. 3. MAKE YOUR PAYMENT.

2011 SPECIAL RETREATS

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

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". - Deposit - 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 RETURN TO MIRAMAR HOMEPAGE