IDR Application Form for Session III (July 19-28, 2021) (This is the form to register and pay the deposit for “IDR Session III”) Click the image to open the flyer Required information marked with *Your TitleMr.Mrs.Ms.Fr.Sr.Dr.Name* First Last Suffix:Age:Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone:*Phone Type*HomeMobileBusinessEmail:*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 July 19 - 28, 2021There is a four-day minimum required.Date of Arrival*Choose date from July 19 through July 26, 2021Time of Arrival*If your arrival date is the first day of the Session (i.e. July 19), your arrival time should not be earlier than 5:00 PM.Date of Departure*Choose date from July 20 through July 28, 2021Time of Departure*If your departure date is the last day of the Session (i.e. July 28), 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 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 CardeCheckCredit Card American ExpressDiscoverMasterCardVisaJCBMaestro Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name eCheck Name on Account Bank Name Routing Number Account Number CheckingSavingsAccount Type Nonrefundable Deposit:*$80 - Summer Session IIIThe application fee is the cost of one night’s stay ($80 or $85); this is nonrefundable and nontransferable but applicable to the cost of the retreat. The cost is: for Summer Sessions (June, July and August): $80 per day, or outside of the Summer sessions: $85 per day.