Marie Joseph Spiritual Center
Attn: Retreat Secretary
10 Evans Road
Biddeford, ME 04005-9561
or call (207)-284-5671 weekdays only, 9AM-4:30 PM

Program:  ____________________________________________

Program Date: _________

Name: _____________________________________________________

Address: ___________________________________________________

City: __________________________ State: ______   Zip ____________+4

Telephone: (Day) __________________(Cell) ____________________

E-mail: _____________________________________________________

Fax: ___________________

Total: Resident $  ___________  Commuter  $ _______

Deposit enclosed:  $65/Weekend ______    $125/Week _______

My donation of $ _____ is for:  ____Scholarships   ___Other