Retreat Registration

Date of Retreat you will be attending: ____________________

NAME: _____________________________________________

ADDRESS: __________________________________________

CITY: _________________  STATE: ___  ZIP CODE: ________

PARISH: __________________  CITY: ___________________

PHONE: ________________ E-MAIL: ____________________

Please mail to:

Our Lady of Good Counsel Retreat House
7303 No. 112th St.
Waverly, NE 68462
Phone: 402-786-2705
Fax: 402-786-7211 (10:00am to 4:00pm only)
Email: goodcounsel@cdolinc.net

The suggested donation is $125.00