Providence College - Connections Retreat Registration


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Connections Retreat


Registration Form	Registration begins June 16th and is first-come, first-served. Please complete the form below and click “submit.” Then mail your deposit to the Chaplain’s Office.
First Name:
Last Name:
Gender:	Male Female
Home Address:
City:
State:
Zip:
E-mail Address:
Phone Number (Cell): Phone Number (Home):
Birthday:
Religion:
Emergency Contact Name: Emergency Contact Phone:
Please check which retreat you wish to attend (check only one): Connections I: Friday-Sunday, September 18-20, 2009 FULL – waiting list available Day of Connections: Saturday, September 26, 2009 Connections II: Friday-Sunday, October 2-4, 2009
Allergies or Dietary Restrictions (please list):
Payment: All Campus Ministry retreats are free for students, but a $40 deposit is required to secure your spot. The deposit will be refunded to all retreat participants at the end of your retreat. Please understand that your deposit will not be refunded if you cancel after September 1st. Your registration is considered complete once we receive a $40 deposit. If we do not receive your deposit by August 1st, your space will be made available to students on the waiting list. Please mail your deposit to: Chaplain’s Office – Connections Retreats Providence College 1 Cunningham Square Providence, RI 02918 Please make checks payable to “Providence College” and write the student’s name in the memo line. If you have any questions about the Connections Retreat or the registration process feel free to call or email Gail Berkowitz, Campus Minister, in the Chaplain’s Office (401.865.2885; gberkowi@providence.edu).

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