PRECIOUS BLOOD SPIRITUAL CENTER      3950 COLUMBIA AVENUE     COLUMBIA, PA 17512-9714
Print out and send this registration form with deposit for retreats / weekend programs

Please print
See "IF YOU BRING A FRIEND... " below.

Name______________________________________________________________________________

Address____________________________________________________________________________

City______________________________________________________State________Zip___________

E-mail address____________________________________

          Phone (home)_____________________________________(work)______________________________

Name of Program___________________________________Date of Program_____________________

Single Occupancy_____ Double Occupancy______  Single with bath (if available, additional fee)_______________

If double occupancy, I wish to room with____________________________________________________

Cost of Program $________                                              Non-refundable deposit enclosed $_____________

Emergency Contact Person's Name_____________________________________________

Emergency Contact Person's Phone Number(s)   (_____)________________  (_____)_______________

IF YOU BRING A FRIEND...
Day of Prayer  - Bring a friend who has never come to our Day of Prayer, and as a thank you gift, you come as our guest!