Full Name: / Preferred name:
Marital status: / Date of birth.
Address:
Email:
Tel Number: / Mob number:
Parish: / Diocese:
Most recent occupation:
Have you discussed your participation on Cursillo with your parish Priest?
Please indicate any disabilities, health problems, dietary requirements etc, which may affect your activities during the weekend.
Please also indicate if you have had a significant bereavement or other life crisis in the past year.
How did you hear about Cursillo?
If single accommodation is limited, would you be prepared to share a room?
The cost of accommodation for the weekend is £210 per person, of which a non-returnable deposit of £70.00 (cheque made payable to “St Eds and IpsCursillo”) should accompany this form. (The cost of weekend can be paid by instalments, preferably standing order - please let booking secretary know if that’s how you wish to pay) The balance is due 8 weeks before the date of the weekend.
Please consider taking out holiday insurance to cover cancellation due to your own unforeseen circumstances. There are funds available for bursaries for those who may need help. If you have any queries, please speak to your sponsor.
SPONSOR : It is usual for participants to be “sponsored” by someone who has already made their Cursillo - this does not necessarily mean financial support. Do not worry if you do not have a sponsor, but please do indicate.
Please hand this completed form to your sponsor requesting them to forward it ASAP the address below.
Name of sponsor: / Address
Tel number: / Email:
Any helpful information from sponsor:
Please return to: Sheila Burnham, 9, Stella Maris, Hadleigh Road, Ipswich, Suffolk. IP2 0DF
Tel: 01473 259931
email:
DATA PROTECTION FORM
St Edmundsbury & Ipswich Cursillo keeps a database of its members, which is used to issue our newsletter and notice of events and any other information. We can only keep details of people who have given us permission to do so. We do not pass names and details on to anyone else. Please complete and sign this form WHETHER OR NOT you want to be kept informed, so that we can be clear about your wishes. This will help us to stay legal!
Please tick either:
YES – I want to be kept informed so please add me to your database:
Or NO - I do not want to be kept informed, please do not keep my details:
If you ticked yes, please write your details here and also indicate below;
NameAddress
Post Code / Tel No.
The Directory:
We produce a Directory of St Edmundsbury & Ipswich Cursillo members names and contact details, which is issued to all those members. This is useful for sending prayer messages, writing to people involved in events, finding other people who live nearby who might like to meet for Group reunions etc.
Please tick either;
YES – I agree that my name can be printed in the above Cursillo Directory:
Or NO – Please do not put my name in the above Directory:
Email List:
This is a closed St Edmundsbury & Ipswich Cursillo list that allows a limited number of authorised people to issue news and announcements (it’s not a chatting forum) If you want to be kept informed in this way, please enter your email address below. Thank you.
YES - I agree to being added to the above email list, my email address is
Or NO Please do not add my name to the email list
Signed: Date
June 2015