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Fall Registration Form

       PLEASE PRINT LEGIBLY                                         REQUIRED INFORMATION     
Name:
Address:
Phone:                                                                  Email:
Emergency HOME Phone:
Male/Female:                                                                  
College/University:                                                     Year of Graduation
Allergies/Dietary/Other special needs:

Do you sing, or play piano, guitar, flute, or other musical instrument?  

Registration Deadline:

RETREAT COST:  $25.00 (covers  lodging, meals and materials)  
                                                           
PLEASE MAKE CHECKS PAYABLE TO:  Catholic Campus Ministry

RETREAT CENTER ARRIVAL TIME:      

RETREAT CENTER DEPARTURE TIME:          
 
Please return forms & registration fee to your Catholic Campus Minister/Advisor

Contact person: Diocesan Office of Campus Ministry                                                   

 Email:  cofcatholics@aol.com