Personal DetailsName* First Last Birthday* DD dash MM dash YYYY Gender*MaleFemaleXMarital Status*SingleMarriedWidowedOtherReligious Denomination (i.e. Catholic, Anglican, United, etc.)* Occupation Spiritual 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 / Zip Contact Phone*Work PhoneEmail* Enter Email Confirm Email Is this a new address or phone number?* Yes No Program DetailsPlease identify the program and date for which you are applying.Program Name*- select -VIRTUAL - 8-Day Directed Retreat (2021/Aug/19 – Aug/27)VIRTUAL - Feminine Mysticism Weekend Retreat (2021/Oct/01 – Oct/03)VIRTUAL - Ignatius & Teilhard Weekend Retreat (2021/Sep/10 – Sep/12)If the program is filled* Cancel my application Place my name on a waiting list For VIRTUAL retreats, please indicate if you are available by Zoom or telephone, etc.* Zoom Telephone Other If you selected "other" above, please specify other methods of communication that will work for you, for example: Google Meets, cell phone FaceTime, What's App, etc. 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 DirectionMost of our retreats are designed for you to meet daily with a spiritual director, to discuss the movements of the Spirit in your prayer. Please note that for weekend and "theme" retreats daily input is provided to guide your prayer. Evening group gatherings are included for sharing the fruit of your prayer. Individual spiritual direction is not included unless specifically requested.If you are signing up for a retreat where spiritual direction is optional, please indicate whether or not you require spiritual direction. Yes No Time Zones - At Loyola House we are in Eastern Time (ET/EDT/EST). Please select ALL the time ranges that you are available for spiritual direction.* 9-11:30 AM (09:00-11:30) ET 1-3 PM (13:00-15:00) ET 3-6 PM (15:00-18:00) ET 6-9 PM (18:00-21:00) ET Not applicable as I do not require spiritual direction If you are attending a directed retreat, what specific requests regarding a spiritual director do you have (i.e. male or female director, Jesuit priest or layperson, etc.)? (Please note that while we strive to meet your preference, we cannot guarantee this. If attending an undirected or weekend or "theme" 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.EmailThis field is for validation purposes and should be left unchanged.