Senior Adult Online Registration Form - You registration will not be received unless you hit the submit button at the end of this form.  If you desire to pay online, please click the Blue "Pay Online" button after you have submitted your form. 

Name *
Name
Address
Address
Phone
Phone
Option One - Pay $100 Online after submitting this form, Pay $90 before October 9. This option includes registration and all four meals at St. Bernard Retreat Center.
Option Two - Pay $125 Online after submitting this form, Pay $115 before October 9. This option includes registration and all four meals at St. Bernard Retreat Center
Option Three - Pay $70 Online after submitting this form, Pay $60 before October 9. This option includes registration, plus four meals at St. Bernard Retreat Center: lunch and dinner on Thursday, and breakfast and lunch on Friday.