Jesuit Retreat House

Oshkosh, WI

April 3 – 6, 2008

Last Name First Name Middle Initial

Mailing Address

City State Zip Code

Daytime Telephone Evening Telephone Cell Phone

Email Address Age

Do you require a first floor room? Yes ___ No ___

Do you prefer first floor room Yes ___ doesn’t matter ____

The Jesuit Retreat House is a non-smoking facility. Smoking is permitted outside except in the courtyard.

I am enclosing my nonrefundable $40 reservation gift. Checks should be payable to Jesuit Retreat House.

Return completed form and check no later than March 1, 2008 to:

Harold R. Meyer

1092 Prairie Rd

Plymouth, WI 53073