Home
Event Listing

Emmaus Encounter: Participant Payment & Retreat Info

"*" indicates required fields

General Information

Name*

First Last

Email*

Your Confirmation Saint or a Favourite Saint:*

Retreat Info

Gender*

Male

Female

Accommodation Preference*

I am ok with double-occupancy room (shared room with same gender roommate, two beds)

I would like to request a private room (additional $100 fee, space-permitting)

Please note that this option depends on availability and is given on a first-come, first-served basis. If there are no more private rooms available, we will refund you $100.

Dietary Restrictions*

None

Dairy-Free

Gluten-Free

Vegetarian

Other

Please indicate any other dietary restrictions and any allergies we need to be aware of:

Emergency Contact*

First Last

Emergency Contact Phone Number*

Emergency Contact Relationship to you*

Allergies or Medical Conditions we should be aware of (You can leave blank if there are none applicable)

Payment Summary

I am paying:*

$650 - Full Program Cost (with Double-Occupancy Room for Retreat)

$750 - Full Program Cost + Private Room Upgrade for Retreat

$0 - My parish is fully covering me

Partial Cost - Please indicate below

Total Amount that you are paying:*

Please specify your portion of the payment here. If you would like to upgrade to a private room, please remember to add the $100 fee. (I.e., if the parish is paying $325 and your balance owing is $325, and you would like a private room, then please be sure to enter $425).

We will automatically invoice the parish for the amount they agreed to pay on the pastor form.

Total

Credit Card