800-456-4197 • FAX 650-726-5394
Healing Retreat  -   November 28-29, 2009
Please list each name as you wish them printed on name tags.

NAME________________________________________________________

ADDRESS____________________________________________________

CITY___________________________________STATE__   ZIP_________

PHONE_________________________EMAIL_______________________

DATE__________________

REGISTRATION FEES: (your canceled check will be your receipt)
Cash_______Check_______Credit Card____

Advance :  $35  2 days until November 20   ................................ $__________
                  $25  1 day  until November  20(   ) Sat   (   ) Sun.......$__________
At the Door:$45 / 2 days  -  $30 / 1 day
I will pray one Rosary daily for the success of the Conference     (        )
Donation to help others attend                                                      $___________

Total Paid (Make checks payable to Saint Raphael Ministries)  $___________

CHARGE: VISA   MC DISCOVER   AMEX
Card No.__________________________________________________________

Exp. Date________________    Signature_______________________________
You can FAX credit card Conference registration to - (650) 726-5394
or   E-Mail: srm.inc@juno.com

Hotel Rooms Reservations: Good Nite - Inn - Single or Double  $69.95 (650)589-7200
                                           Holiday Inn                                                      (650)873-3550
LOCATION :South San Francisco Conference  Center located at
255 South Airport Blvd., in South San Francisco. The Center  is about
10 minutes north of the San Francisco International Airport.
On US 101 North or South take theSouth Airport Blvd exits.
For directions (650) 877 - 8787  Map & Directions