Retreat Reservation Form

Please copy and paste this form into a new word document fill it out and mail this form with a $50 deposit that is non-refundable and non-transferable to:

2709 36th Street N.W.,
Washington, D.C. 20007-1422

Reservations without deposit will not be acknowledged.
To view retreat information click here.

Name ___________________________________
Address _________________________________
City ____________________________________
State _______________Zip code _____________
Home phone ( ) ________________________
Work phone ( ) ________________________
Referred by ______________________________

Dates desired
1st choice __________________at ________________
2nd choice _________________ at ________________

____ I enclose a $50 deposit that is non-refundable and non-transferable.
____ I enclose full payment.
____ No stairs please
____ I need a single room.
____ I will drive alone. I have room for ____ persons.
____ I plan to bring an infant younger than 9 months. (In order to insure recollection, we can only accommodate 3 infants).
____ Special medical diet. We can only accommodate a diet for allergies or diabetics. Please specify which diet.

Office use only:

Application received on ____________________

Confirmation sent on ________________

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