Private SE Waitlist Registration 2

Retreatant's Name*
Prefix First Last
Retreatant's Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Retreatant's Phone*
Home or Cell
- Home
- Mobile
Retreatant's Email*
Parish
Date of birth
MM slash DD slash YYYY
Occupation
How did you hear about this retreat?
Please specify:
Have you ever attended a Spiritual Exercises retreat?
Please specify the group:
Please list emergency contact:*
Name Relationship
Emergency Contact Phone*
Hidden
Please list emergency contact name:*
Hidden
Emergency contact phone:*
Hidden
Emergency contact relationship:*
If you have severe food allergies or mobility issues, please contact us at 248-596-9677 or infousa@mileschristi.org.
Registration per person*
Price:
Additional donation (optional)

I would like to help others attend the Spiritual Exercises!
Total
$0.00
Billing Address*
Same as retreatant's address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Billing Email

Please enter billing email if different from retreatant's email.
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name