Name:
  Address:
  City:
  State:
  Zip:
  Phone:
  Email:
  Parish, Church, or Organization:
  Would you like to be added to the mailing list?
  Would you like to receive a monthly e-mail from Shalom Retreat Center highlighting events happening during the next six weeks?
 

Would you like to register for a program/retreat? (if so, please fill out the questions below):                   


  ┬áProgram/Retreat Title: 
  Date of Program/Retreat:
  Retreat:
  Physical Needs:
  Medical/Dietary Needs:
   

*food allergies diagnosed by a physician (not food preferences). 

If you follow a vegan diet, you must call us at least one week in advance to discuss.

 

How did you hear about this program/retreat?