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PRE-CANA REGISTRATION
FORM—
(Please
print legibly—Your
Certificate will reflect accordingly)
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Names:
Groom
Bride:
(Maiden)
E-Mail
Address |
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Address for Correspondence (Name/Address, City, State, Zip) |
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Telephone( )
________________
Cost: $75 per couple: CK#
________________Enclosed Wedding Date:
_________________________ |
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Credit Card:MasterCard/VISA/DISCOVER
Acct # _______________________________________________________Exp.
Date___________________ |
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Name on Card:_________________________________ Signature
(for Credit Card payment only)_____________________________________________ |
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Address as appears on Credit Card
(if
different from above):
___________________________________________________________________________
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2012 Dates: Feb 19
______April 15 ______ May 20 _______ June 10 _______ July 22
_______ Aug 19 _______ Oct 14 _______ |
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Please complete
reservation form and mail, along with your deposit to: Loyola Retreat House, 700 Killinger Rd. Clinton, OH
44216-9653. For
more information call
(330) 896-2315. Thank You!
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