Christian Awakening Retreat 
November 12th, 13th, & 14th, 2010
    
Sponsored by: 
Catholic Campus Ministry 
847 South Holland Avenue
Springfield MO 65806
Phone - 417-865-0802

For more information about Awakening, click here.

Please Complete the Entry Form below completely.
 Do not use the Enter Key, but use the Tab key to move to the next field.
Then press the "Enroll me." button at the bottom of the form.


    

Name:                          School: 

Mailing Address:     

City,  State,  Zip         

Phone:                   E-Mail 

Local Emergency Contact:      Phone: 

Parent's Name      Phone: 

T-Shirt Size  (Small,  Medium,  Large,  Extra Large) 

How you heard about our retreat?

In the following field, please include any food allergies or special needs we should take into consideration for the weekend.

If you have any questions regarding the retreat, please contact Catholic Campus Ministry 
or Kelsey Gaines (Rector) - Gaines89@Live.MissouriState.edu.

Registration Deadline is (Contact Kelsey Gaines)?

Make Check of $25.00  payable to  Catholic Campus Ministry,  (Please indicate on your check:  "e-mail registration")

 and mail to:       Catholic Campus Ministry 
                           847 South Holland Avenue    
                           Springfield, MO  65806-3513. 

 


Your Entry Form is being sent to the Kelsey Gaines, Awakening Retreat Rector,
at Catholic Campus Ministry.