Our Lady of the Pines

Retreat Center

Website Retreat Registration Form

Print this page and mail to OLPRC 1250 Tiffin Street; Fremont, OH 43420

FAX (419) 333-0238, send as attachment, or Copy/Paste and send to E-mail.

Name

Address

City/ST/Zip

Telephone

Name of Retreat

Retreat Date

Method of Payment: Check No. Money Order

MasterCard VISA

Card No.

Expiration Date: 3-Digit Code (on back)

Retreat Deposit Amount: $

Special Instructions or Requests: