Upper Room Retreat – February 2025 Registration InformationThis form is to register as an overnight participant for the Upper Room Retreat at The Ark and The Dove in February, 2025 . 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) * * * OPTIONAL OFFERING * * *Retreatants are invited to attend optional pilgrimages after the retreat on Sunday afternoon of February 23, 2025 and on Monday, February 24, 2025.(Required)On Sunday afternoon, we will visit the chapel at Duquesne University. On Monday, we will visit the Franciscan University of Steubenville. 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. 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 Travel InformationPlease provide any travel information so that we can prepare for your arrival.Planned Arrival Date:(Required)Please indicate which date you will arrive at The Ark and The Dove. We ask all retreatants to arrive by Friday, February 21, 2025 before 5:00pm. Retreatants may arrive on Thursday, February 20, 2025 if that will provide easier travel. Thursday, February 20, 2025 Friday, February 21, 2025 I am unsure at this time Other 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 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, February 23, 2025 around 2:00pm. Optional pilgrimage opportunities will be offered on Sunday afternoon and Monday. Guests are invited to depart by Tuesday, February 25, 2025. I will depart on Sunday, February 23, 2025 I will depart on Monday, February 24, 2025 I will depart on Tuesday, February 25, 2025 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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