Name
Special Intentions:
Light a Votive Light for your Intentions: (What a burning candle means) None selected $25 (Votive Light for six months) $15 (Votive Light for 90 days) $10 (Votive Light for 60 days) $50 (Votive Light for one year)
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: ** AB AL AK AZ AR BC CA CO CT DE DC FL GA GI HI ID IL IN IA KS KY LA LB MA MB ME MD MI MN MS MO MT NB NC ND NE NF NH NJ NM NS NT NV NY OH OK ON OR PA PE PQ PR RI SC SD SK TN TX UT VI VT VA WA WV WI WY YT ZIP/Postal code Are you already on our mailing list? Yes No If so, 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)
Return to the bulletin. Send in your special intentions.
Association of the Miraculous Medal 1811 West Saint Joseph Street * Perryville, MO 63775 1-800-264-6279* ammfather@amm.org
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