SSM Form 501-D&G (2016)
Retreat Registration & Information
Name____________________________________________E-Mail____________________________________________________
Address__________________________________________ City _______________________________ State_____ Zip________
Home Phone_____________________________________ Work/Alternate Phone_______________________________________
Program Desired_________________________________________________ Dates _________________to___________________
Payment Type: _____Check _____ Deposit Enclosed:________________
$25 Non-refundable deposit on retreats up to $99; $50 on retreats $100 - $199; $100 all others;
$10 Non-refundable deposit on day retreats/workshops under $50
The cost of each retreat program greater than the price listed.
Any additional amount that you can afford to donate above the cost of the retreat/program is greatly appreciated.
Gift Certificates can be purchased for all or part of a retreat cost.
If other than a directed retreat, do you want private spiritual direction? ____Yes ____No ($30/Hour Session)
The following information is requested for those registering for a guided or directed retreat.
Answering the following questions will help us prepare spiritually and practically for your retreat.
1.
Is this your first retreat? ___________ If not, how long has it been since your last retreat? ______________________
2.
What types of retreats have your made? _________________________________________________________________
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3.
Have you ever made a directed retreat? ______ When? ____________________________________________________
Was the director a man or a woman? __________
4.
What made you decide to make this retreat? ______________________________________________________________
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5.
Do you pray regularly? _______ Briefly describe the way(s) in which you pray. ________________________________
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6.
Describe any difficulties you are experiencing in prayer at this time. _________________________________________
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7.
What are your expectations for this retreat? ______________________________________________________________
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8.
Do you have any particular concerns or other comments about this retreat? __________________________________
____________________________________________________________________________________________________
9.
Please list any special needs; be specific, i.e., diet or mobility concerns. _____________________________________
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10.
Are you a member of a particular faith tradition? _____ Denomination _______________________________________
Return completed form and deposit to: Servant Song Ministries, 720 East Greene Street, Waynesburg, PA 15370
For questions, please call: 724-852-2133