CORAZÓN AT VILLA ST. DOMINIC

Registration for Corazón/Villa St. Dominic Programs

To Register for the opportunities, please print out the form below and mail it with your deposit check (payable to Villa St. Dominic) to:
Sr. Katherine Gaffney, OP
Villa St. Dominic
P.O. Box 189
Glasco, N.Y. 12432
Phone (845) 246-8941
FAX (845) 246-5610

Name ______________________________________________
Address ____________________________________________
______________________________________ Zip Code __________
Phone (      ) ___________________
Opportunities Chosen________________________________
Dates______________
If Directed Retreat:

Director: 1st Choice________________________________
2nd Choice______________________________________

Deposit: $25 (applied to total fee)
Amt. Enclosed __________
Please make check payable to Villa St. Dominic

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