Paulist Mission Society Enrollment Form

Please print this form and fill it out for your first enrollee.

On a separate piece of paper, clearly write out additional names to be enrolled, as well as the desired keepsake (Pieta, Our Lady of Guadeloupe, or Dove) and where to send keepsake for each additional enrollee.

Mail form and additional enrollee information to:
The Office of Financial Development
North American Paulist Center
3015 Fourth Street N.E.
Washington, D.C. 20017-1102
 

Please enroll:                                                                                    

Enrolled by:                                                                                   

Address:                                                                                     

City                                                   State                  ZIP                                                               

Phone Number:                                                            

Email Address:                                                                                   


Keepsake Choice:

___ Agony in the Garden  ___ Pieta  ___ Our Lady of Guadeloupe

Mail keepsake to:

Address:                                                                                     

City                                                   State                  ZIP                                                               


PAYMENT INFORMATION:

I wish to pay via        Credit card        Check/money order (please mail to address at top of form)

Charge my offering of $15 each to my credit card, for a total of $___.

Name on Credit Card:                                                                                     

Credit Card Number                                                                                     

Expiration Date (mm/yy):                                  

Card type (circle one): American Express MasterCard VISA Discover