St. Monica Women's
ACTS Retreat
August 2-5, 2012
Registration Form

The ACTS Retreat provides
opportunities for each retreat
participant to form a deeper
relationship with our Lord through:

Adoration and daily prayer;
Community with others;
Theology & study of our Faith;
Service to Others

Welcome to the online registration for the Women's ACTS retreat. This form uses a secure interface.
Retreats are open to both Catholics and non-Catholics. Participants must be at least 18 years old. .
The retreat will be held at the Catholic Coference & Formation Center in Dallas, TX.
Partial scholarships may be available - please contact retreat director (contact information listed below) to discuss further if you would like to attend but have financial concerns.

The Registration process is as follows:
    1. Complete one form for each person attending.
    2. Fields with an (*) are required.
    3. If you need to make changes later, fill out another form with the same exact name.

When all the required fields have been filled out, you will be given an opportunity to pay online. The retreat fee is $185 and can be paid when you register or you can make a deposit of $100. The Remaining balance will be due at sign-in in August

Title:    First Name *    Middle Name    Last Name *    Suffix    Nickname

Email Address *

Phone Numbers * (at least one is required):
Home     Cell

Address     City     ZIP

Your Parish:

Month of Birth *     Day of birth *

Relatives or friends also attending:

Please list any special needs such as difficulty walking, special diet, medical issues, medications, allergies, etc.

Emergency Contact Information
Name (primary) *     Phone *
Email Address *
Street:    City:    State:    ZIP:

Name (secondary) *     Phone *
Email Address *
Street:    City:    State:    ZIP:

Kristin Buehler
St. Monica Women's ACTS
7315 Blairview Dr.
Dallas, TX 75230

Please join us in praying every day for the retreat.