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ACTS Men's Retreat — Application

Full Name

Email Address

Phone Number

Home Address

Parish / Home Church

Emergency Contact Name

Emergency Contact Phone

Loved One's Name

Relationship

Loved One's Phone Number

Dietary Restrictions or Special Needs

Who invited you to this retreat?

Shirt Size

A
B
C
D
E

Payment Information

Cash or check payable to: St. Rose of Lima - ACTS
Mail to: 615 Vine Ave, Roseville, CA 95678
Pay by CashApp and Venmo. Details will be provided directly once application is received.
Please include your full name in the payment memo so we can match your payment to your application.