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RESERVATION
FORM—”Evening of
Reflection: Praying with St. Francis of Assisi”— $30 per person
(For Credit Card
payment; name as it appears on the card and statement address)
Program Date: September 22, 2010 |
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Name
MI
Last
Name
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Address
City
State
Zip |
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( )
________________ ( )_________________
Email Address (For Confirmation)
______________________________________________ |
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Daytime
Phone Evening Phone (Please
Note* Confirmation will only be sent via Email ) |
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Parish or Affiliation______________________________ |
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Payment
Method: Check
_____
Cash_____ DISCOVER/VISA
/MasterCard_______________________________________________
_________________ |
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(Circle One) Credit Card
Number
Exp. Date |
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Signature (for Credit Card payment only)
______________________________________________ |
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Please complete
reservation form and mail, along with your payment to: Loyola Retreat House, 700 Killinger Rd. Clinton, OH
44216-9653. For
more information call
(330) 896-2315 or (800) 827-1416. Thank You!
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