Wufoo

Name First Last
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number ### - ### - ####
Email
Home Parish
Diocese
Emergency Contact Name
Emergency Contact Phone Number ### - ### - ####
Emergency Contact Relationship
Age Group
Under 21 21 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70+
Please list any special accommodations (We will try to make accommodations with at least 10 days notice)
Prayer Requests (will be placed on the altar during weekend masses)
How do you plan to pay? You may pay online at the end of this form, or you can mail registration and check to:
S. Sandusky
c/o MCWC
11 North Streeper Street
Baltimore, MD 21224 *
Pay Online Mail Check

If you will be mailing a check, please disregard the PayPal payment page that will load at the end of this form. You will receive an email with your confirmation information.
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