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Association of the Miraculous Medal
Become a Member

Membership and Your Free Miraculous Medal
So that we can get to know our members better, we would like you to fill out the information below. In gratitude for your support, we will send you a free Miraculous Medal upon request.

This offer applies only to addresses in the United States and Canada.
Would you like to receive a free medal? view this medal (Your medal will be blessed at the Shrine.)  
Please fill out your information below:  * required fields
First Name
Last Name
Email Address
Date of Birth

Postal Address:
(second line)
 Zip Code:
Country:  (US or Canada only)
Optional Information
Phone number:

(no dashes)

Second number:
(no dashes)

What is your religious affiliation?

Mailing Information
If you live in the United State or Canada, the Association offers many services by mail. You may write us at any time.
You may contact me about future events via email:  
Courtesy information
How did you hear about our web site?