8 day Retreat – Lumko Retreat Centre, Benoni

– Registration Form –

Friday 6pm,8th December 2017– Saturday ± 16h30, 16th December 2017

47 Dickinson Road, Brentwood Park, Benoni North,Gauteng

Thank you for registering for the 8-day retreat. We look forward to welcoming you.

Please complete the attached e-form, save and send back as an attachment by email; alternatively print clearly in black ink and fax to 086662 9662. Please return as soon as possible. Note: We reserve the right not to accept a registration, if in the view of the retreat co-ordinator the applicant is not likely to manage the demands of a silent 8-day retreat.

Surname
First Name / Title
Denominational Background
Telephone / Work / Cell
Address
Address / Postal code
e-mail
Name and contact number of person to contact in an emergency
Please list any special dietary, health or access needs
or any other problems we need to be aware of
Payment due / *Details below /  Electronic Transfer
Signed / Date
(If the form is emailed, sending from a personal address will be deemed to be equivalent to signing). Total cost R4950 due by 30th October2017. Deposit of R2000 by 28th August 2017. Should you cancel before the end of October a 10% admin fee will be deducted from refund paid back to you! No refunds will be made at short notice.
Residential retreats are often oversubscribed and so please be aware that in giving you a place on this retreat we have had to say no to someone else. If we do not receive your full deposit and full payment by the dates given we cannot guarantee you a place on the retreat.

Please email proof of payment to or fax to 086662 9662

Account Name: The Jesuit Institute Trust Account Number:300087 659

Bank:Standard BankBranch Code:006105

Our reference:‘8 day Retreat’ + surname of retreatant

Credit card Payments are accepted via SnapScan / PayFast. Please go to our website and click on the PAY tab for details.

□Please tick should you not wish to be added to our mailing list

In order for us to be confident that it is a good time for you to make an 8-day retreat and also to match you with an appropriate spiritual director, we ask if you would give the information below. This information will be kept confidential and will only used as part of the selection process and for the purposes of matching you with a retreat director. If you would like an opportunity to discuss what you have written with one of the staff of the Jesuit Institute, please indicate this on the form and we will contact you.

  1. Have you been on an individually directed eight-day retreat before? If so when and if not, what other retreats have you been on?
  1. Please describe the characteristic pattern and length of your daily prayer at the moment?
  1. Are you currently in Spiritual Direction? If yes for how long?
  1. Is there a particular decision that you are hoping the retreat will help you to make?
  1. Are you experiencing any particular difficulties in your life at the moment which you hope might be clarified or resolved as a result of making this retreat?
  1. Are you on any medication fordepression or anxiety or any other similar psychological conditionor have you been in psychotherapy at any time over the past five years? (Please notea 'yes' response to this questiondoes not necessarily mean that you will not be accepted for the retreat).
  1. Is there anything else you think itmight be helpful for us to know?

Margaret Backwell

Jesuit Institute School of Spirituality

Email:

Tel number: 011 4824237

Fax number: 086 662 9662

Cell number: 071 608 5966