Complete this form and click on "Submit" below to register online for the Convocation and Ministerium, OR .....

Make a copy of the completed form  and mail to St. Bernard’s School of Theology & Ministry, 120 French Road, Rochester, NY  14618, Attn: Ellen Morningstar, Registrar, with a check payable to "St. Bernard's" or credit card information.

 

 

(Online registration requires payment by credit card)

Program registration due by April 5, 2007

Last Name       
First Name:    
Address:        
           City:       State:    Zip:
Day Phone:    Ext:              Parish, City: 
E-mail:          

  Do you have any special dietary requirements?

  DINNER CHOICES:   Chicken   Salmon  Vegetable Napoleon           

                   COST:  $100.00     Retired Priest (no conference fee)

Billing Instructions:                               

               Select American Express Discover Master Visa

Acct #    Exp. Date:  Mo 01 02 03 04 05 06 07 08 09 10 11 12   Yr 03 04 05 06 07 08 09 10 11 12     Name on Card:

(Note: If you will not be paying by credit card (retired priest), you will need to select a month and year in expiration date fields)