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ACTS Registration and Payment
ACTS Retret Registration and Payment
Contact Information
Name
First Name
Last Name
Prefered (nick) Name:
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Home Phone
*
Cell Phone
*
Email
*
Verify Email
*
Family Contact
*
Relationship
*
Family Contact phone number
*
Family Contact Email
*
Are you Catholic
*
YES
NO
Are you registered parishioner at St. Cecilia's?
*
YES
NO
Do you have any special needs?
Amount
*
$328