Reservation Form

RESERVATION FORM

Please print and return form with deposit to:
St. Raphaela Center
616 Coopertown Road
Haverford, PA 19041-1135

Phone: 610-642-5715
Fax: 610-642-6788

Name: _______________________________________________

Phone (Area Code) ______________________________

Email Address __________________________________

Address ________________________________________

City _____________________ State ______ ZIP _____________

Name of retreat or program ____________________________________

Enclosed is my non-refundable deposit of $ _________
(See program for amount: one-day programs, multiple day retreats)

The actual cost of each retreat and program is considerably higher than the price listed. Any additional amount that you can afford above the listed cost of the retreat/program is greatly appreciated.