A.C.T.S. - Diocese of Amarillo

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Adult Retreat Registration and Payment

- Please note: Although we prefer online registration, if you need a mail in form, you can get one here.
  
  Please complete the following form to finish
  your registration for the
  ACTS Retreat
  
  (All Information will be kept confidential)
  
  For retreat or registration information contact Norma Frausto at 806-683-4623
  or
  eMAIL
  
  Final Payments for the retreat can be made by clicking the button below!
  (This is only if you have already completed the form below and paid the deposit payment!.
  Final Payment
- The maximum number of form submissions has been reached. This form is currently not available.
  
  Select Retreat
  
  Which Retreat are you registering for? REQUIRED Please fill out this field.
  
  Are you Registering as a Retreatant or Team Member? REQUIRED Retreatant ACTS Team Member Please fill out this field.
  
  Registration Form (Part A)
  
  Payment Verification REQUIRED I will pay the $100.00 deposit which leaves a balance of $100.00 owed I will pay the $200.00 fee in full Please fill out this field.
  
  Participant's First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Participant's Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Sex REQUIRED Male Female Please fill out this field.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter valid data.
  
  Home Phone REQUIRED Please fill out this field. Please enter valid data.
  
  Cell Phone Number Please enter valid data.
  
  Registration Form (Part B)
  
  Who Introduced You to ACTS? Please enter valid data.
  
  Phone Number Please enter valid data.
  
  Are you married?
  
  Has your spouse attended an ACTS Retreat?
  
  Are they scheduled to attend?
  
  Are you a practicing Catholic?
  
  If so What Parish/Church? Please enter valid data.
  
  Do you practice another faith?
  
  Church/City Please enter valid data.
  
  Dietary and Medical Needs
  
  Will you have any specific dietary or medical needs during this weekend?
  
  My needs are
  
  I am allergic to Please enter valid data.
  
  Emergency Contact Information
  
  Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.
  
  Relationship Please enter valid data.
  
  Final Payment: A deposit of $100 will guarantee your spot for the retreat. Full payment must be received on or before the date of the retreat. If only paying your deposit today, please visit our payment page to make your final payment.
  
  Payment Type REQUIRED 100.0 – Deposit 200.0 – Full Payment Please fill out this field.
  
  Total:
  
  Submit
  
  Proceed to Payment
  
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Adult Retreat Registration and Payment

Please note: Although we prefer online registration, if you need a mail in form, you can get one here.

Please complete the following form to finish your registration for the ACTS Retreat

Please complete the following form to finish
your registration for the
ACTS Retreat