PERSONAL INFORMATION

Name

Local Mailing Address

Home Mailing Address (if same as above, leave blank)

Preferred Phone Number

E-mail address (e.g., ffalcon@bgnet.bgsu.edu)

Date of Birth --- January February March April May June July August September October November December --- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Are you Catholic? Yes No

Gender? Male Female

What is your University Status?
Freshman
Sophomore
Junior
Senior
Graduate Student
International Student
Non-BGSU Student - College Attending:

Department, office, or academic major

BGK shares your information with other participants of your retreat to keep in touch after the weekend.
Please click the box if you do NOT want your information shared.

If there is any additional information you need to provide, please include it in the text box below
(i.e., dietary needs, special accommodations, etc.).

After you submit this form, please return to the St. Thomas More Koinonia page to make your payment through PayPal. Alternatively, you may make a check for $35.00 payable to St. Thomas More and submit it to the parish office (425 Thurstin Ave., Bowling Green, OH, 43402).