Prefix Mr.
Mrs.
Ms.
Dr.
Rev.

First Name *

Last Name *

Email *

Preferred Name *

Mailing Address *

City *

Province * Alberta British Columbia Saskatchewan Manitoba Ontario Prince Edward Island New Brunswick Northwest Territories Newfoundland & Labrador Nova Scotia Nunavut Quebec Yukon

Postal Code *

Phone *

Please indicate your age. * Select ... 18 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 +

Are you currently married? * Select ... Yes No

What is your spouse's name?

Is your spouse attending the upcoming set of weekends? Select ... Yes No Undecided Unknown

Has your spouse attended a previous Cursillo weekend? Select ... Yes No Unknown

We would very much like to inform your pastor of your involvement with us, which is why we are requiring the following information.

Parish or Church Name

Parish or Church City

Priest's or Pastor's Name

Priest's or Pastor's Email

Are you baptized? * Select ... Yes No Unknown

Sponsor's name *

Sponsor's phone number *

Sponsor's email *

Has your sponsor explained the nature and purpose of the weekend? * Select ... Yes No

Do you have any medical conditions or disabilities? * Select ... Yes No

If yes, please explain

Do you have any food allergies? * Select ... Yes No

If yes, please explain

I agree to have my name included on Cursillo weekend lists and mailouts * Yes No Undecided

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