1. Please register and pay for Day Programs, in full, by 14 days in advance of the program date. We do not take deposits for day programs.

2. Please register for Retreats that include overnight stays with a deposit of $75 or the entire fee at the time of registration. Payment in full is due 14 days prior to the program start date.

3. Deposits are non-transferrable and nonrefundable, should you cancel your registration.

All meals are served buffet style in our dining room. Please let us know of dietary restrictions with this form.

The Mariandale Center reserves the right to cancel a program or retreat if a minimum number of registrants are not met. Cancellations by the Center are fully refundable.

If you want to pay by check, please fill/print this form out, and mail it with your check, payable to Mariandale, to:
The Mariandale Center
299 N. Highland Ave., Building 5
Ossining, NY 10562

OR, to Pay by Credit Card, please fill out and submit the form below.
Please enter the Retreat(s) and/or Program(s) in the spaces below: 
Retreat / Program 1  
Retreat / Program 2  
Retreat / Program 3  
Retreat / Program 4  
Retreat / Program 5  

Pay a Deposit Now ($75 for Retreats that include overnight stays)

OR, Pay the full amount of the program fee now

I would like to add a donation to support Mariandale
Total amount:   $0.00  (U.S. Currency)

Credit Card & Check/Debit Card*

Visa Mastercard Discover American Express

Routing Number

Your Information
First Name *
Last Name *
Billing Address*
U.S. Phone
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Emergency Contact
Emergency Phone

Make the Most of Your Stay at Mariandale

(Please note that we cannot provide gluten free meals)
(If you need vegetarian meals, please let us know two weeks in advance of the program start date.)

* All payments provided to The Mariandale Center comply with U.S. laws and regulations.
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The Mariandale Center
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