IDR Application Form for Outside Summer Sessions (Sept-Apr) Please make sure your dates have been approved by the front office before submitting your application. Required information marked with *Your Title:Mr.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 September through April.There is a four-day minimum required.First choice of dates from:* MM slash DD slash YYYY First choice of dates to:* MM slash DD slash YYYY Second choice of dates from: MM slash DD slash YYYY Second choice of dates to: MM slash DD slash YYYY Time of Arrival:* Time of Departure:* 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 diet Vegetarian diet 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:* $95- Outside of Summer Sessions The application fee for individually directed retreats is the cost of one night’s stay ($95); this is nonrefundable and nontransferable but applicable to the cost of the retreat. The cost is: for outside of the Summer sessions: $95 per day.CAPTCHA
