Fr. Daniel Brandenburg, LC
Retreat Director

Contact Candy Nesbit at cnesbit@legionofchrist.org or (203) 915-6384

Registration

Qty

Description

Amount

Total

I/We will attend the Spiritual Retreat for Men

$250.00

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select number attending. $250 per person

I am not able to attend, but would like to make a donation in the amount of

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Total: $0.00

Attendee Information

Please enter the names of attendees

Attendee 1 Name:

Your Information

First Name: *

Last Name: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Telephone:

Number Above is: *

We will only call if there is a problem processing your payment

E-mail: *

A receipt will be e-mailed to this address.

Alergies or Special Needs:

Your Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *

Name on Account: *

Routing Number: *

Account Number: *

Fr. Daniel Brandenburg, LCRetreat Director