10-21-23 DOM Registration Form - Emmaus Ministry For Grieving Parents

10-21-23 Diocese of Madison Registration Form

Offered by St. Mary of the Immaculate Conception and St. Mary Help of Christians

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Registration Selection*

Please register for this retreat by completing this form. If you have any difficulty completing it, please call Diane at (800) 919-9332 or email her at [email protected].

Please indicate your status.*

This is my first Emmaus Ministry retreat.

This is not my first Emmaus Ministry retreat.

I am a current or future retreat team member; I am not a grieving parent.

I have participated in Emmaus Ministry retreats at (where?)

Name - Primary*

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Email - Primary*

Phone - Primary*

Address - Primary*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent 2 Name

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10-21-23 Diocese of Madison Registration Form

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