| Either print the form on this page or the PDF file form, fill it out and mail with deposit to this address:
Dominican Retreat
7103 Old Dominion Drive
McLean, VA 22101-2799
| Retreat |
Deposit
|
| Weekend |
$60
|
| Day of Recollection |
$20
|
| Week Long Retreat |
$60
|
| Evening of Recollection - no meal |
-
|
| Evening of Recollection - meal |
$20
|
Reservations may be made by mail (check or credit card information included), by telephone, fax
or email (credit card information required). All deposits are non-refundable.
| Retreat Date |
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| Retreat Program |
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| Amount Enclosed |
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| Full Name |
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| Address |
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| City |
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| State |
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| Zip |
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| Email Address |
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| Telephone - Work |
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| Telephone - Home |
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| Special Needs |
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| Method of Payment |
Check or Credit Card (Visa or Master Card) |
| Credit Card # |
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| Expiration Date |
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| Amount Charged |
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| Signature |
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