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St. Francis Xavier - TBP Registration Form
St. Francis Xavier Retreat - November 17-19, 2023
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* Indicates required question
First Name:
*
Your answer
Last Name:
*
Your answer
Street Address:
*
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City:
*
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State:
*
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Zip:
*
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Phone:
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Email:
*
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Your response to these questions will help us prepare your accommodations:
Gender:
*
Your answer
I request a room for couples *
(based on availability; please list other name below;
please note that the cost for the weekend remains the same
)
Yes *
No
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* Requesting to share a room with:
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Any health, dietary needs or allergies of which we should be aware:
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In case of an emergency, whom shall we notify?
Name and Phone Number:
*
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Name and Phone Number:
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Please include any other information you think might be helpful to us:
Your answer
Thomas Berry Place
Kelli@ThomasBerryPlace.org
929-357-6700 x205
www.ThomasBerryPlace.org
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