User account

If you have been practicing centering prayer on a regular basis and are in a 12-Step program of recovery you may be added to our 12-Step Outreach database. We hope to let you know of retreats, workshops or opportunities for service if you are interested.

Account information

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E-mail address: *

A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.

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Personal Information

Name: *

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Address:

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City: *

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State:

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Zip/Postal Code:

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Phone Number:

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Primary program of recovery:

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No. of. yrs.:

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No. of yrs. Practicing CP:

Have you previously attended a CP Workshop/Retreat?: --YesNo

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Where?:

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When?:

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Have you previously attended an Intensive Retreat?: --YesNo

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Where?:

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When?:

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Have you completed Formation with Contemplative Outreach?: --YesNo

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Where?:

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When?:

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Have you completed Formation with 12-Step Outreach?: --YesNo

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Where?:

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When?:

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Are you currently in a 12-Step Centering Prayer group?: --YesNo

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Where?:

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How often does it meet?:

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Are you currently in a non 12-Step Centering Prayer group?: --YesNo

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Where?:

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How often does it meet?:

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Do you attend a 12-Step meditation meeting?: --YesNo

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Where?:

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