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Register Online

- Parish Life A-H

For online registration, please fill out the form below and mail in your deposit of $75 to:
St. Joseph ACTS
567 St. Joseph Lane
Manchester, MO 63021

To pay by credit card, use this link. Please note that the credit card link is for payment only. The form below must be filled out to register for the retreat. Thank you!
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- Retreat you are registering for: REQUIRED Please fill out this field.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Name as you would like it to appear on your name tag REQUIRED Please fill out this field. Please enter valid data.
- Street Address REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Cell Phone Number Please enter a phone number.
- Phone Number Please enter a phone number.
- Parish, or church REQUIRED Please fill out this field. Please enter valid data.
- Emergency Contact #1
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Relationship REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Emergency Contact #2
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Relationship REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Any special physical, dietary, medical, or other needs for the retreat weekend? REQUIRED Yes No Please fill out this field.
- If "yes" please tell us about them:
- Comments
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Saint Joseph Parish

567 St. Joseph Lane, Manchester MO 63021

Register Online