Diocese of Madison
Men's Lenten Retreat - March 5-6, 2010
Online Registration

Complete the entire form and then click the 'Submit' button at the bottom of the page.
Do not use the 'Enter' key.

Each person registering must complete and submit either the printed form or this online form.
If you have questions, please call 608-821-3160 or e-mail OEC@straphael.org.


Registration type (and associated fee):

First Name:
Last Name:
Parish:
City where parish is located:
Your preferred mailing address:
     Street address:
     City:
     State:
     Zip:
Email Address:
Daytime phone:


Please call if you need a sign language interpreter or other assistance which may require advance preparation.



Make checks payable to "Diocese of Madison" and mail to:
       OEC -- ATTN: Men's Retreat
       P.O. Box 44983
       Madison, WI 53744-4983

 When submitting payment, please clearly indicate who payment is for.