3-Day Retreat Registration Form

Mother Of the Redeemer Retreat Center
Three Day Retreat Reservation Form

To register for a retreat, use your PRINT button to print this Registration Form, then Complete the Registration Form, and:
1. Send it to: Mary's Children; P.O. Box 27; Washington, IN. 47501 -- or --
2. Call 812-825-4642 -Extn 200 or Fax the completed registration form to Mary's Children at: 812-254-0469 or 812-825-4642
3. You can contact Mary's Children by clicking here to send an email for answers to questions.
4. Prices Include: Room for 2 nights, Friday & Saturday, 2 Breakfasts (Sat & Sun); 2 Meals: Lunch & Dinner (Sat)
A confirmation will be sent to you by way of an email. Send Email confirmation to:
Print email address here: _________________________________________________________________
( ____) I do not have an email address. Please send my confirmation by postal mail or a telephone call.

Please Indicate The Retreat For Which You Are Registering:
My Selection	Date of Retreat	Retreat Title	Retreat Director(s)
_____	Feb 17-19, 2012	Family Retreats (Two Retreats Given) One for Adults & One for Children	Fr. Joachim Mudd FI Fr. Elias Mills FI
_____	March 16-18, 2012	G.K. Chesterton and how he has something to say about the situation of the present state of society and culture.	Dale Ahlquist of the G.K. Chesterton Society on EWTN

Please indicate if children accompanying adults will be attending the Children's Retreat.
______	Yes, children will be attending the Children's Retreat while adults attend the above listed retreat.

Please Select A Registration Category From Among Those Listed Below:
My Selection	Guest Accommodations	Cost Of Retreat	Amount Sent	Office Use
_________	Single Room - 1 Person	$145	_____________	_________
_________	Couples - 1 Room (2 persons & Children)	$190	_____________	_________
_________	Each Additional Non-Family Person Staying Overnight	$35 (Includes meals)	_____________	_________
_________	Commuter Registration	$35 (Includes meals)	_____________	_________
Commuters do not stay overnight, but do partake in meals served during the retreat. All check-in by 6:15pm Friday.

Special Diets: If you require a special diet, please know that we are not able to provide them. Sorry, no exceptions.

Indicate Name(s) & Contact Numbers Of Each Adult Registrant & The Names/Ages Of Children Attending Children's Retreat
Name: Address:	____________________________ ____________________________	Phone:_____________________ City:________________________	State: ____ Zip:_______
If no email address provided, then the confirmation goes to the person listed above.
Name: Address: Name: Address:	____________________________ ____________________________ ____________________________ ____________________________	Phone:_____________________ City:________________________ Phone:_____________________ City:________________________	State: ____ Zip:_______ State: ____ Zip:_______
Child's Name: ______________ Age: _____ Child's Name: ______________ Age: _____		Child's Name: ______________ Age: _____ Child's Name: ______________ Age: _____
Each child's age is needed so those directing the Children's Retreat will know what age groups plan to attend. If any questions regarding reservations, contact Guest House at: 812-825-4642 Extn 200