Personal DetailsName* First Last Birthday* Date Format: DD dash MM dash YYYY Gender*MaleFemaleXMarital Status*SingleMarriedWidowedOtherReligious Denomination (i.e. Catholic, Anglican, United, etc.)*OccupationSpiritual Ministry (if applicable)Contact InformationAddress* Street Address Address Line 2 City State / Province / Region AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Postal Code / ZipContact Phone*Work PhoneEmail* Enter Email Confirm Email Is this a new address or phone number?*YesNoProgram DetailsPlease identify the program and date for which you are applying.Program Name*- select -CANCELLED - Advent Taizé Weekend (2020/Nov/27 – Nov/29)CANCELLED - Directed Prayer Weekend (2020/Dec/04 – Dec/06)CANCELLED - Incarnating Advent Retreat Weekend (2020/Dec/04 – Dec/06)VIRTUAL - Advent Weekend Retreat (2020/Nov/27 – Nov/29)If the program is filled*Cancel my applicationPlace my name on a waiting listFor VIRTUAL retreats, please indicate if you are available by Zoom or telephone. Zoom Telephone VIRTUAL Individual Directed RetreatIf applying for an individual retreat within one of our virtual 5- to 8-day directed retreats, please tell us which days you prefer to be on retreat.Virtual Individual Retreats - List the dates you prefer to be on retreatSpiritual DirectionIf you are signing up for a weekend retreat where spiritual direction is optional, please indicate whether or not you require spiritual directionYesNoIf you are attending a directed retreat, what qualities would you like in a spiritual director? (Please note that while we strive to meet your preference, we cannot guarantee this. If attending an undirected retreat, just note "not applicable")What are your personal reasons for going on retreat? (Please choose all that apply.)* Silence & Prayer Ignatian spirituality Personal growth Rest and relaxation Inner healing Connect with the land Other If you chose "other" above, please add your reason(s) below.What types of retreats have you made? (Please choose all that apply.)* Silent Directed 8-Day This is my first retreat Have you made a retreat at Loyola House before?*YesNoHave you made the full Spiritual Exercises of St.Ignatius?*YesNoIf yes, please specify which one or both: 30-Day Annotation 19 Also, if yes, when and where?Marketing InformationHow did you hear about this retreat? (Please choose all that apply.) Family/Friend Community Spiritual Director Internet Advertisement Parish Bulletin Returning Retreatant ConfidentialityAll information received will be maintained in the strictest confidence and no data will be sold, distributed or in any other way communicated to individuals or organizations not directly related to Ignatius Jesuit Centre.PaymentAfter submitting your application below, payment instructions will be given to you with registration confirmation. We ask that you do not pay until then. Thank you.PhoneThis field is for validation purposes and should be left unchanged.