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ACTS Retreat Registration Form
Men's ACTS Retreat
September 21-24, 2023
Contact us at 503.547.7479
william.miller@providence.org
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Attendee Information
First and Last Name
*
Your answer
Birthdate
MM
/
DD
/
YYYY
Home Address
*
Your answer
Mobile Phone
*
Your answer
Home Phone
*
Your answer
Religious Preference
Your answer
Parish
Your answer
Dietary / Health Needs
Your answer
Emergency Contact Information
Emergency Contact Name
*
Your answer
Emergency Contact Phone
*
Your answer
Emergency Contact Email
*
Your answer
Referral Question
Did and ACTS member or St Pius parishioner encourage you to attend the retreat? If yes, what is their name:
Your answer
Payment Information
Your registration form and a non-refundable deposit of $50 must be submitted in order to reserve your place.
The full cost of the retreat is $355 and includes all transportation, food, and lodging.
Deposit or Full Payment?
Check and Online payment information is listed below, how would you like to pay today?
*
$50 (Deposit)
$355 (Full)
Paying by check
Online payment
Required
Pay Online
Click the following link to pay online using our "Other Payments" WeShare Form:
https://www.wesharegiving.org/App/Form/fdb3e719-753e-4c3c-819b-476bc2b859bc
Be sure to put "
Men's ACTS Retreat
" in the memo area
Pay by Check
Make Checks Payable To:
St. Pius X
Add a Memo of:
Men's ACTS Retreat"
Additional Notes
Your answer
We look forward to seeing you at the Men's ACTS Retreat. May God bless you!
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