Name
Address
City/State/Zip	City State Zip
E-Mail Address
Phone Number	Home: Cell:
Requested Date(s)	First Choice Alternate Choice
Choose one:	Retreat Center Rustic Hermitage
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Emergency Contact	Name Phone
How did you hear about us?	Fr. Paul A Brochure Our Website A Retreatant Assumption Abbey A Board Member Other
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The Hermitage Spiritual Retreat Center is a not-for-profit corporation
governed by a Board of Directors of many Christian traditions,
open to all persons seeking spiritual renewal.

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