Fill out this form to register for Settling Into Priesthood Seminar

Your Information

*First Name:
*Last Name:
*Diocese:
*Date of Ordination:
Birth Date:
*Address:
*City:
*State/Province:
*Zip:
*Phone:
Cell Phone:
*Email Address:
Best Method of Contacting You:	E-mailTelephoneCell Phone
*Current Assignment:
*Position:
Travel Plans:	DrivingFlying
Please describe any dietary requirements or special accommodations below:

Event Information

*Retreat Name:
*Event Date:
Handicap-accessible room
*Arrival Date:
*Departure Date:

Fee Selections

Options	Quantity
Workshop, with Transition Facilitator on site ($ 1,550)	0 1 2 3 4
Workshop, with Transition Facilitation by phone ($ 1,225)	0 1 2 3 4
Name and address of the registrant above must match the credit card used for payment.

If you prefer, you can print this form and mail it, with your check, to:
Saint Meinrad Institute for Priests and Presbyterates
200 Hill Drive
St. Meinrad, IN 47577

Payment also can be made via credit card (MasterCard, Visa or Discover)
by calling (800) 357-8477 or (812) 357-6439.