Private Retreat Payment Private Retreat Payment Form This form may be used to pay the deposit, outstanding balance, or payment in full for private retreats after the retreat dates have been confirmed. It may also be used to pay for spiritual direction sessions. Name* Mr.Mrs.MissMs.Dr.Sr.Br.Rev. Prefix First Middle Last I have confirmed my private retreat dates with the Retreat Center office.* Yes No (If selecting "No", please contact the Retreat Center office before completing this form.) Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Email* Phone*Please provide the best number to reach you:Preferred name for name badge Payment of deposit to confirm registration*Individual deposits to hold reservations for Retreat Center-sponsored events or private retreats are non-refundable. The deposit is not an additional fee. It is subtracted from the final invoice. If you cancel your reservation more than 30 days prior to your scheduled arrival date or the date of the event, your deposit will be fully refunded, less a 10% service charge. The refund request must be in writing or by email. If cancelled less than 30 days prior to your arrival, deposits are non-refundable. Payments made beyond the deposit amount will be refunded less a 10% service charge. This request must be made in writing or by email. If the Retreat Center cancels an event, deposits will be fully refunded. Refunds may be by check or by credit card, at our discretion. I have read and understand the deposit policy.Private retreat depositAfter your retreat dates and the amount due have been confirmed by the Retreat Center Office, you may pay the $50 deposit here. The balance will be due before or upon arrival. Private retreat balance due or payment in fullAfter your retreat dates and the amount due have been confirmed by the Retreat Center Office, you may pay the entire amount below, or the balance due of you have already paid a deposit. Spiritual Direction in Person or OnlineAfter your spiritual direction dates and the amount due have been confirmed, you may pay the amount due here. Optional donationIf you would like to add a tax-deductible donation to your retreat payment, please enter the donation amount here. Total $0.00 To complete your transaction:After completing the credit card information, please ensure that the transaction is completed by clicking the SUBMIT BUTTON at the bottom of the form (after the "captcha"). Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name Cardholder's Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.