Icon Painting Workshop 2024 Registration – Jesuit Spirituality Center

Icon Painting Workshop Registration (May 31 – June 6, 2024)

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Title

For example, Mr., Mrs., Miss., Sr., Br., or Fr.

Name*

First Last

Address*

Mailing Address Address Line 2 City State ZIP / Postal Code

Cell Phone*

Birth Date

Occupation

Religious Affiliation

Email Address

Enter Email Confirm Email

Emergency Contact*

A name and phone number to contact in case of an emergency

Special Needs

*PLEASE NOTE: At this time we are only able to accommodate documented medical dietary restrictions. If you have dietary preferences, you are welcome to bring your own food, and we will happily provide space in one of our kitchen refrigerators for you. Microwaves are also available for use.

Icon Painting Workshop Deposit (Required)*

Price:

Workshop Balance (Due By End of Retreat)

Option to pay full retreat fee. Choose desired option from drop down list.

Total

Credit Card

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MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

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Phone

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