Registration Form
Arrival Date/Time:
Friday, October
19, 2007 – Arrive 6:00pm – 6:45pm
Departure Date/Time:
Sunday, October 21, 2007 – Depart 2:00pm
Cost: $135.00/person
(includes accommodations; 3 meals Saturday, 2 meals Sunday)
What to Bring:
Bible, Rosary, Breviary (if you have one)
Ø Please complete and return Registration Form with your
nonrefundable deposit of $50 to secure your reservation. Checks should
be made out to: St. Benedict
Weekend Retreat.
Ø
Send Registration and deposit
to: Sally Piragis, 82 Cleveland Street, Greenfield,
MA 01301. .
Ø Registration Form
and deposit are now due. Space is limited.
Ø Complete a separate Registration for each retreatant. (Please
make copies as needed.)
PLEASE PRINT
Name : _________________________________________________________________
(First)
(Last)
What name do you go by?_________________ Date of Birth:_________________________
Address:_____________________________________________________________________
(Street)
(City) (State)
(Zip)
Daytime
Phone: ________________________Evening Phone: ___________________
Email:_____________________________________ Check one: Male ____ Female _____
If
you will be rooming with a family member or friend, please list their name and relationship:
_____________________________________________________________________________________
Emergency Contact Name/Phone:__________________________________________
Liability Release
The
undersigned do hereby release, forever discharge and agree to hold harmless Sally J. Piragis, and her agents, and forever
discharge and agree to hold harmless Fr. Steven McGuigan, and his agents, and forever discharge and agree to hold harmless
St. Benedict Abbey, and their agents, and forever discharge and agree to hold harmless the Diocese of Worcester, and their
agents, from and against any and all liability, claims, demands, lawsuits, and expenses of any kind arising from personal
injury, sickness, death, or property damage of any kind whatsoever which may be incurred or suffered by the undersigned.
Furthermore,
the undersigned hereby assumes all risk of personal injury, sickness, death, damage and expense arising from the undersigned’s
activities including recreation and retreat activities during the Weekend Retreat Conference.
Further, authorization and permission is hereby given to furnish
all necessary food and lodging for the undersigned.
Signature of Retreatant:__________________________________________________________Date:______________
Print Name:_________________________________________________________
For More Information
Contact Sally Piragis at: (413) 774-6855
Email: spiragis@verizon.net
