Family Encounter Weekend

November 29, 30, and December 1, 2019
McShain-Horstmann Family Life Center
at the Malvern Retreat House
315 S. Warren Avenue, Malvern, PA 19355

Family of 3: $395.00, plus $25.00 for each additional child under 21 yrs old

Includes board & lodging for 3 days/2 nights, six meals, snacks and program materials

Please register on or before November 20, 2019.

Family Last Name *

First Name : Dad

Date of Birth

MM/DD/YYYY

First Name : Mom

Date of Birth

MM/DD/YYYY

Child (1) Full Name

Date of Birth

MM/DD/YYYY

Child (2) Full Name

Date of Birth

MM/DD/YYYY

Child(3) Full Name

Date of Birth

MM/DD/YYYY

Child(4) Full Name

Date of Birth

MM/DD/YYYY

Child(5) Full Name

Date of Birth

MM/DD/YYYY

Address

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone (1)

Home Phone (2)

Mobile Number : Dad

Mobile Number : Mom

Email : Dad *

Email : Mom *

Schedule of Donation

Name