Form Test - Emmaus Ministry For Grieving Parents

05-31-25 Diocese of Madison One-Day Retreat Registration Form

In Cooperation with the Diocese of Madison, St. Thomas Aquinas Parish, and the Emmaus Ministry for Grieving Parents

"*" indicates required fields

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*

First Last

Email - Primary*

Phone - Primary*

Address - Primary*

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

Parent 2 Name

Use this field to enter any additional guest names.

FREE WILL OFFERING (OPTIONAL)

Your optional donation will be used to help offset our costs of providing these retreats. Suggested donation: $50/Individual; $75/Couple.

Donation Amount

Coupon

Total

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Stripe Total

Credit Card

Card Details

Cardholder Name

Phone

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