Application for the fall 2020 Silent Retreat at Mother Cabrini Shrine - Nov 20-22, 2020
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Instructions for completing the application:
* All applications will be reviewed by a staff member of the Lanteri Center    
* Refunds will be issued for those whose applications are not accepted at this time
* Check in is before 5 pm for orientation, schedule review and room assignment. Please make every effort to stay through the end of the retreat on Sunday afternoon

Please submit a 50% deposit with your application -

If paying by check please indicate on the MEMO line of your check that the payment is for the Fall 2020 Silent Retreat

Checks may be sent to:
Lanteri Center for Ignatian Spirituality, 416 22nd Street, Denver, CO 80205  

If you wish to pay by credit card, please note that there is a small processing charge of $4.  You can pay by credit card from our donations web page by clicking here: https://www.omvusa.org/lanteri-center/donate/         
Please indicate on the SPECIAL INSTRUCTIONS line of your check that the payment is for the Fall 2020 Silent Retreat
Personal Contact Information
Applicant's Name: *
Applicant's Email Address: *
Applicant's Mailing Address: *
Applicant's Telephone: *
Retreat Length: *
Required
Emergency Contact Information
Emergency Contact Name: *
Emergency Contact Relationship: *
Emergency Contact Phone Number: *
For a Better Appreciation of Your Personal Spirituality
[All this information will be kept confidential]
Have you made a silent retreat before? *
Was it personally directed or guided? *
Are you currently in spiritual direction? *
What prompts you to make this retreat? *
What desires, expectations, hopes, fears or concerns do you have for this retreat? *
What have been some of the major influences affecting your personal life/spirituality? And how have they affected you? (Example: Parents/Family) *
Favorite/Scripture/Passages: *
 Moments of major decisions (Vocation/Change/Conflict) Conversion Experiences: *
What is your present ministry/occupation *
Religious Affiliation *
Required
Check One: *
Date of Birth: *
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What Parish do you attend? *
Medical Information Section
Are there any past or current medical conditions or information that we need to be aware of? *
Are there allergic conditions that we need to be aware of? (Including medication allergies): *
Do you currently take medications? If yes, please list medications: *
Will you have any special needs during this retreat? If yes, please explain: *
Do you have medical background/training? If yes, please explain: *
Alternate Emergency Contact Name & Phone Number: *
Health Insurance Company: *
Health Insurance Phone Number: *
Policy Holder Name: *
Group Number: *
Date of Application: *
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Signature: *
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