Men&#039;s ACTS Retreat Online Registration

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Address: REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Home Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Work Phone Number Please enter a phone number.

Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Age Please enter valid data.

Email REQUIRED Please fill out this field. Please enter an email address.

Other Means of Contact Please enter valid data.

Marital Status: Married Single Widowed

Name of Spouse or a friend: Please enter valid data.

Spouse's or Friend's Phone Number Please enter a phone number.

Spouse's or Friend's Email Please enter an email address.

Name(s) of other persons (not going on the retreat) whom we can call to pray for you:

First Name Please enter valid data.

Last Name Please enter valid data.

Phone Number Please enter a phone number.

Email Please enter an email address.

First Name Please enter valid data.

Last Name Please enter valid data.

Phone Number Please enter a phone number.

Email Please enter an email address.

Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.

Relationship to Emergency Contact Please enter valid data.

Emergency Contact Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Emergencyt Contact Email REQUIRED Please fill out this field. Please enter an email address.

Have you ever attended a Men's ACTS Retreat? REQUIRED Yes No Please fill out this field.

If yes, when and where? Please enter valid data.

Parish or Church you attend? Please enter valid data.

City that your Parish or Church is located Please enter valid data.

Religion Please enter valid data.

Did someone invite you to this retreat? Yes No

If yes, who? Please enter valid data.

Will you have specific dietary, medical, or physical needs during this weekend (i.e. Prescription meds, trouble walking on the retreat grounds, etc.)? REQUIRED No Special Needs Yes, see below: Please fill out this field.

Please write down your special needs during the weekend.

The registration fee is $250.00 Please Check One, option for your payment. I have included my registration fee of $250.00 CK#___________THANK YOU! I would like to make payments. Included is my deposit of $_____ CK#__________ I will need financial assistance. Call me at _________________(phone)

Please make checks payable to St. Justin Martyr. PLEASE DROP OFF AT THE CHURCH OFFICE OR MAIL TO Men's ACTS Retreat, St. Justin Martyr, 13350 Ashford Point Drive, Houston, TX 77082. Before November 1, 2024.
You will receive a confirmation letter prior to the retreat with details regarding your attendance at the retreat.

Men's ACTS Retreat Online Registration

Online Payment