Please print this page, or copy & paste &
print the form only.
This is not an automatic e-mail return form. After printing it, please fill it in, and mail it, via the US Postal Service, along with your deposit to the address below. Thank you.
NAME______________________________________________
Street Address _______________________________________
City, State, Zip Code _________________________________
Telephone _________________ E-mail____________________
Religious Affiliation (Denomination) _______________________
Retreat/Workshop Title _______________________________________
Retreat/Workshop Dates _____________________________________
Special Dietary Needs? ________________________________
___________________________________________________
Diabetic _________________ Vegetarian _________________
OTHER SPECIAL REQUIREMENTS __________________________________________________
To secure your reservation,
please send this form along with a $35.00 non-refundable* deposit to:
St. Scholastica Center
Retreats/Workshops
P.O. Box 3489
Fort Smith, AR 72913-3489
Payment by: Check ______ Credit Card _____
Credit Card Type: Visa______ Mastercard______
Credit Card # _________________________ Expiration Date (Mo/Yr) _____________
Three-digit security code on back of card _________ Signature _______________________________
* if you find you are unable to attend, please notify us immediately.
please send this form along with a $35.00 non-refundable* deposit to:
St. Scholastica Center
Retreats/Workshops
P.O. Box 3489
Fort Smith, AR 72913-3489
Payment by: Check ______ Credit Card _____
Credit Card Type: Visa______ Mastercard______
Credit Card # _________________________ Expiration Date (Mo/Yr) _____________
Three-digit security code on back of card _________ Signature _______________________________
* if you find you are unable to attend, please notify us immediately.