Form- Upper Room Retreat Upper Room Retreat- September 2024 Registration Form Registration InformationThis form is to register as an overnight participant for The Upper Room Retreat at The Ark and The Dove. Participant Name(Required) First Last Birth Date(Required) MM slash DD slash YYYY Gender(Required) Male Female Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone(Required)May we text you at this number?(Required) Yes No WhatsApp NumberIf you have a WhatsApp number, please enter it here. If you are traveling internationally, we will use WhatsApp to contact you. Email(Required) Tell us more about you!Name of Your Parish/Church Community(Required)How did you hear about The Upper Room Retreat?(Required)Have you been to The Ark and The Dove before?(Required) Yes No Optional Offerings:Retreatants may arrive on Thursday, September 5, 2024 if that will provide easier travel.(Required)Will you be arriving on Thursday, September 5, 2024? I will arrive on Thursday, September 5. I will arrive on Friday, September 6 by 5:00pm. I am not sure of my travel arrangements. Retreatants are invited to attend optional pilgrimage date on Monday, September 9, 2024.(Required)The pilgrimage details will be provided at a later date, but will include visits to Duquesne University, Franciscan University of Steubenville, and other sites in the greater Pittsburgh area. Yes, I will attend the optional pilgrimage days. No, I will not attend the optional pilgrimage days. I have not yet decided whether or not I will attend the pilgrimage days. Travel InformationPlease provide any travel information so that we can prepare for your arrival.How will you be traveling to The Ark and The Dove? Flying to Pittsburgh Driving Bus Other Will you need transportation from Pittsburgh airport? Yes No I am not sure Planned Arrival Date:(Required)Please indicate which date you will arrive at The Ark and The Dove. We ask all retreatants to arrive on Friday, September 6 before 5:00pm. Thursday, September 5, 2024 Friday, September 6, 2024 I am unsure at this time Other Arrival Flight Time (Please use Eastern Standard Time)If you have not purchased your flight, please skip this question. Hours : Minutes AM PM AM/PM Arrival Flight AirlineIf you have not purchased your flight, please skip this question.Arrival Flight NumberIf you have not purchased your flight, please skip this question.Planned Departure Date(Required)Please indicate which date you will depart from The Ark and The Dove. The retreat will officially end on Sunday, September 8, 2024 around 2:00pm. Optional pilgrimage opportunities will be offered on Sunday afternoon and Monday. Guests are invited to depart by Tuesday, September 10. I will depart on Sunday, September 8. I will depart on Monday, September 9. I will depart on Tuesday, September 10. Other Below, please tell us your planned arrival date, arrival time, and departure date, departure time:Please list any dietary restrictions, if applicable:We will do our best to accommodate special dietary restrictions, but we may consult you for food options. Any other comments or questions?Payment InformationPlease note that your registration fee is a donation. We suggest a donation of $150.00 for the Upper Room Retreat. If you intend to participate in the optional Pilgrimage Days, we will invite an additional donation to help offset the associated costs. Registration Fee donation amount:Suggested donation amount is $150.00 Total
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