A.C.T.S. Registration Form
Name *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Name as you want it to appear on your name tag: *
Your answer
Address *
Your answer
ZIP code *
Your answer
Email *
Your answer
Home phone *
Your answer
Work or other phone
Your answer
Emergency contact *
Your answer
Relationship to emergency contact *
Your answer
Emergency contact's address *
Your answer
Emergency contact phone number *
Your answer
Special needs for the retreat weekend
Your answer
Home parish you attend *
If you listed "Other," what church do you attend?
Your answer
Is this your first A.C.T.S. retreat? *
Do you play a musical instrument?
If so, what do you play?
Your answer
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This form was created inside of Saint James Catholic Church.