CORNERSTONE XXIII Registration

The cost of the retreat is $80.00.

Please mail a check made payable to Saint Helen's Church to:

Saint Helen's Church
Attn: Cornerstone Retreat
1600 Rahway Avenue
Westfield, NJ 07090

If cost is an obstacle, please contact Ellen Murphy at EllenMurphy811@gmail.com or (908) 322-3411.

If you prefer to register by mail, a printable version of the registration form is available for download.
* required
Select Women's or Men's Retreat:  

 
General Information  
* Are you a Saint Helen's Parishoner?:
* First Name:
* Last Name:
* Address:
* City:
* State:
* Zip Code:
* Home Phone:
* Mobile Phone:
* Email Address:
* Date of Birth:  
Medical Information:
* Do you transportation TO/FROM the retreat?
 
Emergency Contact Information  
First Contact  
* Emergency Contact Name
* Emergency Relationship
* Emergency Contact Phone
* Emergency Contact Mobile Phone
* Emergency Contact Email Address
Second Contact  
Emergency Contact Name
Emergency Relationship
Emergency Contact Phone
Emergency Contact Mobile Phone
Emergency Contact Email Address
 
Please answer the following questions. We’d like to get to know you.
* Marital Status
If married, Number of Years
* Do you have any children?
* Do you have any siblings?
   
* Current or Former Occupation:
* Please list any pets you have:
* Your Favorite TV Show:
* Heritage (Italian, Chinese, Spanish, etc):
* States/Countries you have lived in/visited:
* Favorite Group/Singer:
* Your Interests and Hobbies::