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Retreat Registration Form
All retreat forms due at least two weeks before retreat begins
Please indicate Retreat Date when sending.

__ Women's Retreat - Date: _________________ Deposit: $30.00/ Total Fee:$90.00

__ Holy Week Retreat - Date: ________________ Deposit: $30.00 / Total Fee: $90.00

__ Men's Retreat - Date: ____________________ Deposit $30.00 / Total Fee: $90.00

__ Women's Prayer Day: ___________________ Deposit/Total Fee: $15.00

Name:_____________________________________________________________

Address:___________________________________________________________

City:_________________________________________ State:_____ Zip:________

Phone: (______) __________________ E-mail:____________________________

Amount Paid: _______________ Deposits are not refundable within the two weeks prior to the retreat.

Send registration and fee to:

St. Benedict Lodge
56630 North Bank Road
McKenzie Bridge, OR 97413

More information: sblodge@opwest.org (541) 822-3572

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