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Enter Group Retreat Dates

Please use separate Forms when your Contact or Retreat House is Different

Group Number:
 
Retreat Dates (up to six retreats)
Start Date:
End Date:
Start Date:
End Date:
Start Date:
End Date:
Start Date:
End Date:
Start Date:
End Date:
Start Date:
End Date:
     
Group Contact
Name:
Phone Number:
       
Retreat House
Name: City: State/Province:
     
Information Submitted By
Name: Group and Medallion:
email:

 

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