Our Lady of Perpetual Help
Retreat and Spirituality Center

Diocese of Venice, FloridA

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Payment for Pre-arranged Retreat

If you have already arranged an individual retreat with an OLPH staff person
and have been directed to this page, please continue below to make your payment.
The maximum number of form submissions has been reached. This form is currently not available.
- This page is used only for retreats and other payments previously approved by OLPH.
- Retreatant First Name REQUIRED Please fill out this field. Please enter valid data.
- Retreatant Last Name 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 a zip code.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Enter Retreat/Event Name and Date REQUIRED Please fill out this field.
- Please identify if you have any food allergies or medically-required dietary restrictions? Please note that OLPH is limited in its ability to accommodate special dietary needs. We CANNOT accommodate Vegans.
- ----- EMERGENCY CONTACT INFORMATION -----
- This information is to help us, as well as to provide EMT and health care professionals with important information in case of a medical emergency.
  
  Please note: EMTs are trained to ask questions about a person’s age, current medication, emergency contact numbers, and important medical history.
- Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.
- Emergency Contact Relationship REQUIRED Please fill out this field. Please enter valid data.
- Emergency Contact Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- ----- PAYMENT INFORMATION -----
- Payment Type REQUIRED Please fill out this field.
- Payment Amount (you will have the option of paying by debit card, credit card, or eCheck): REQUIRED $ Please fill out this field. Please enter a positive decimal.
- Registration is not complete until you
  Proceed to Payment
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