Retreat Registration

Please reserve a space at the _____________________________ Retreat

Name: ________________________________________________________________


Address: ______________________________________________________________


City, State, Zip: _________________________________________________________


Phone: __________________________E-Mail: ________________________________


         Enclosed is my deposit of _____________ for the _________________________ Retreat


I will room with: ________________________________________________________
          □ Please find me a room mate                                                                                             

Please enclose a $25 non-refundable deposit and Mail to:
Fr. John Campoli, PO Box 1951, Brick, NJ 08723