:Light a Votive Light for your Intentions:   (What a burning light means)
None selected $25 (Votive Light for six months) $10 (Votive Light for 60 days) $15 (Votive Light for 90 days) $50 (Votive Light for one year)

I wish to have the following persons remembered during the month of May and especially in the Mass at the Shrine on Mother's Day, May 14. (To burn a Votive Light at the Shrine for a loved one, just check the box below.  The usual offering for each 60 day Votive Light is only US$10.)

Your Name and Address: 
Title: (Mr., Mrs., Miss, Rev.)
First Name:
Last Name: Suffix: ** Jr. Sr. MD DDS PHD II III
How would you like us to address you? ("Dear Pat") Dear 
Email address:
Postal Address:
(second line...)
City:  State: 
ZIP/Postal code
Are you already on our mailing list? Yes No
If yes, what is your member number? What's this?
(If you don't know or can't find your member number, we can still process your request)

Would you want to receive emails from us? Yes No

If you experience any difficulties during this process, please call us at 1-800-264-MARY (6279).