IDR Application Form for Session I (May 13 - 22, 2024) To register, please complete this form and submit with the required non-refundable, non-transferable deposit. Required information marked with *Your TitleMr.Mrs.Ms.Fr.Sr.Br.Dr.Name* First Last Suffix: Age: Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Phone Type* Home Mobile Business Email:* Emergency Contact’s (EC) Full Name* Emergency Contact’s (EC) Phone Number* EC’s Relationship to the Retreatant* Occupation/Ministry: Religious Affiliation: Choose Dates from May 13 - May 22There is a four-day minimum required. {Minimum of 4 complete days = 96 consecutive hours)Date of Arrival* Choose date from May 13 through May 18, 2024Time of Arrival* If your arrival date is the first day of the Session (i.e. May 13), your arrival time should not be earlier than 5:00 PM.Date of Departure* Choose date from May 17 through May 22, 2024Time of Departure* If your departure date is the last day of the Session (i.e. May 22), your departure time should not be later than 10 AM.) Preference for director: No preference Laywoman Sister Priest Do you or have you had a Spiritual Director? If current, how long have you been in direction? If past, how long has it been since you have received spiritual direction?Special needs: First floor room Diabetic Vegetarian Have you made a directed retreat before?YesNoIs this your first retreat?YesNoIf No, where have you made a retreat and when was it? Are you confident and comfortable with a totally silent retreat? What are you hoping for in this retreat? (e.g., quiet time with God, direction in prayer, making important decisions, etc.)Additional Comments:Payment Method:* Credit Card eCheck Credit Card American ExpressDiscoverMasterCardVisaJCBMaestroSupported Credit Cards: American Express, Discover, MasterCard, Visa, JCB, Maestro Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name eCheck Name on Account Bank Name Routing Number Account Number CheckingSavingsAccount Type Nonrefundable Deposit:* $90 - Summer Session I The application fee is the cost of one night’s stay ($90 or $95); this is nonrefundable and nontransferable but applicable to the cost of the retreat. The cost is: for Summer Sessions (May, June, July and August): $90 per day, or outside of the Summer sessions: $95 per day.
