(Print this page and mail to the Address below.)

ACTS Retreat September 18 - 21, 2008

(All information is kept strictly confidential)

Name:                                                                                           

Age:                     Sex: M / F Marital Status:                                 

Address:                                                                                      

City:                                                   State:                                 

Zip:                                     

Hm. phone:                               Cell phone:                                   

E-Mail Address:                                                                            

Parish/Church:                                                                             

In case of an emergency,

Contact:                                                                                        

Relationship:                                                                                 

Hm. phone:                               Wk. phone:                                  

Do you have any special needs?

(Wheelchair access, Diet, Medications, etc.)

Cost of the Retreat is $130.00

□ I have enclosed $50.00 for my registration fee and will pay the balance at check-in.

□ I am unable to pay the full cost of the Retreat, but I have enclosed $               and I will need a scholarship for the remaining amount.

□ In order to attend I will need a full scholarship.

Mail to:

ACTS Retreat

P.O. Box 100535

San Antonio, TX 78201-8535

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