| Your E-mail |
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| Your Name |
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| Please select one of the following:
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| Your Address Please |
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| Telephone number |
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| Request weekly envelopes |
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| Request planned giving information |
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| Adult Family members (names) |
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Children
(Please include date of birth
and date and parish of Baptism) |
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| Housebound |
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| Would like to receive Holy Communion |
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| Previous address, if changing |
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