FIRST NAME(Required)LAST NAME(Required)DATE OF BIRTH(Required) MM slash DD slash YYYY PHONE(Required)EMAIL(Required) MAILING ADDRESS(Required)CITY(Required)STATE(Required)ZIP(Required)PARISH(Required)DIOCESE (CITY/STATE)(Required)EMERGENCY CONTACT — NAME(Required)EMERGENCY CONTACT — PHONE(Required)DIETARY NEEDS OR ALLERGIES(Required)ACCESSIBILITY OR SPECIAL NEEDS(Required)LODGING (ALL MEALS & OVERNIGHT STAY ARE PROVIDED AT NO COST)(Required) Staying overnight (Fri & Sat) Commuting daily HOW DID YOU HEAR ABOUT THIS WEEKEND?(Required)WHERE ARE YOU IN YOUR DISCERNMENT? ANYTHING YOU’D LIKE THE SISTERS TO KNOW? (OPTIONAL)By registering I consent to attend this discernment weekend. I understand the program is offered at no cost.SIGNATURE(Required)DATE(Required) MM slash DD slash YYYY
