Hosted Retreat — Individual Registration | Durward's Glen Retreat Center

Hosted Retreat — Individual Registration

Form type Hosted Retreat — Individual Registration (HR)

Event

Form #

Quote this number when you pay — how to pay.

For individuals joining a retreat that Durward's Glen is hosting.

Questions? Call (608) 356-8113.

Participant

Participant name

Today's date

Participant email

Participant phone number

Mailing Address

Mailing address — street

City

State

ZIP

Dietary and Accessibility Needs

Food allergies Leave blank if none. This goes straight to our kitchen.

Other allergies or accessibility needs

Event Details

Name of event / retreat

Event leader

Start date

Start time

End date

End time

Event public or private Public Private

Retreat Fee

Retreat fee — choose one Weekend Commuter One day only

Fee amount ($) If the amount was published with the retreat, enter it. Otherwise leave blank and we will confirm.

Discounts

I am registering early (may qualify for a 10% discount — the office confirms)

Guardian of the Glen membership Not a Guardian Supporter ($47 monthly) — 10% Champion ($97 monthly) — 20% Guardian discounts are applied by the office before your invoice is issued.

Additional Requests

I would like a priest available for Mass / Confession

Anything else we should know?

Required fields marked *

Other ways to use this form

💳 Already registered? Pay online

"Print my filled copy" prints what you've typed so far so you can sign it and mail it in instead of submitting digitally.