Special Intentions:

Light a Votive Light for your Intentions:   (What a burning candle 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 June and especially in the Mass at the Shrine on Father's Day, June 17.

(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:  ** AB AL AK AZ AR BC CA CO CT DE DC FL GA GU 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 PR PQ RI SC SD SK TN TX UT VT VA VI WA WV WI WY YT     ZIP/Postal code
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