Registration
To register,please print out this form and mail it with your payment to: Our Lady of Calvary Retreat Center
Colton Street,
Farmington, CT 06032
Date of Weekend:
 Nameof Program:
 Date of Program:

Name:

Address:

City:

State:

Zip Code:

Telephone:

Parish:

Parish City:

E-Mail Address:

Please Indicate Room Choice (choose only one):

Single Double Triple       Commuter Saturday

Roommate(s) Name(s):

Physical/Dietary Needs:

Total Cost of Program:      
(Total amount to be charged to your credit card)

Payment Method:
Visa Master Card

Card Number:

Expiration Date:                  Security Code:
         

Credit card payments must be made in full,or you may make your $50 deposit by check and your balance due will be collected upon your arrival.  Simply print out this completed form and mail it with your payment.