Name of Retreat:_________________________________________________________________
Dates: from ________________to_________________________year_______________________
Retreat cost: $____________[including materials fee, if any]
Total cost: $______________
Deposit : $_______________[full payment due at time of registration] [check or money order only]
PERSONAL INFORMATION
Name:____________________________Address:________________________________________
Phone:___________________E-mail:___________________Occupation:_____________________
Please note any food allergies, dislikes, and considerations:__________________________________
________________________________________________________________________________
Related Personal Growth Experience:___________________________________________________
Things that I am looking forward to on this retreat:_________________________________________
Would you like to schedule a retreat for a group?
If yes: describe retreat______________________________________________________________
date of possible retreat_______________________________________________________
Send registration and payment to: The Haven of Grace, P.O. 224, Woonsocket, RI 02895 Tel. 401-766-0284
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