02-15-23 Diocese of Albany Midweek Registration Form - Emmaus Ministry For Grieving Parents

REGISTRATION INFORMATION

If you have any problems completing this form, please email [email protected]

Parent Name-1*

First Last

Registration Selection*

Are you registering as an individual or as a couple?

Parent Name-2

First Last

Email*

Phone*

Address*

Street Address City State ZIP Code

RECORDING*

Parts of this retreat that do not include personal interactions, will be recorded, so that we can offer it virtually to other parents via the Emmaus website. Do you understand this?

Yes
No

FREE-WILL OFFERING-OPTIONAL

Your optional donation will be used to help offset our costs of providing virtual programs. Any donation of any amount is deeply appreciated, but not necessary.

How much would you like to donate?

Total

$0.00

Credit Card

Card Details

Cardholder Name

Name

This field is for validation purposes and should be left unchanged.

02-15-23 Diocese of Albany Midweek Gathering Retreat

REGISTRATION INFORMATION

FREE-WILL OFFERING-OPTIONAL

Title