Return your registration form to:

St. Joseph Renewal Center

1725 Brentwood Road

Brentwood, NY 11717

631-273-1187  x411 

Along with your registration form, please  make your check out to Sisters of St. Joseph.

NAME:___________________________________________________________________

ADDRESS:________________________________________________________________

PHONE NUMBER:__________________________________________________________

EMAIL ADDRESS:__________________________________________________________

I AM REGISTERING FOR:_____________________________________________________

DATES:___________________________________________________________________

SPECIAL NEEDS, IF ANY:____________________________________________________

REFERRED BY:_____________________________________________________________

DO YOU HAVE A FRIEND YOU WOULD LIKE US TO EMAIL OUR WEBSITE TO. PLEASE PROVIDE THEIR NAME AND EMAIL ADDRESS BELOW.