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1 People in your group

Guest 1		First Name* Last Name* Email*
Guest 1		First Name* Last Name* Email*

2 Retreatant Information

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Last Name *
Address *
Address 2
City *
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Zip/Postal *
Country *
Email *
Phone *
Additional Food Notes	If you entered "more than one" above, please describe. Otherwise, enter "none."
Which of the following best describes you?	I am unable to climb stairs and need a 1st floor room I prefer a 1st floor room, but if necessary I can go to the 2nd floor I can walk to the 2nd floor, but not the 3rd floor I can climb stairs without difficulty and walk up to the 3rd floor if needed There are limited rooms on the 1st floor. People with physical limitations have priority.
Comments or Special Needs
SRC Email newsletter	Please send me St. Raphaela Center's newsletter
Handmaid News	Would you like to periodically receive a newsletter from the Handmaids?
Group Guidelines *	I have read and agree to the responsibility for my group following the Center's group guidelines.Please read the Center's Group Guidelines

3 Donate

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$	St. Raphaela Center Donations contribute to the maintenance of the Center and its mission.
$	Retreatant Scholarship Program Provide the opportunity for others to experience a retreat for whom this would otherwise not be possible.

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