Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Confirm Preaching Date *

MM

DD

YYYY

Are you willing to administer the Sacrements? *

Yes

No

Are you willing to wear the alb/vestments (white robe)? *

We will have one available if you do not have one of your own vestments.

Yes

No

Unsure/would like to discuss