Spiritual Union Enrollment Form - Franciscan Friars of the Atonement

Yes, I would like to Enroll in the Graymoor Spiritual Union

Suggested Donation $12

Enrollee Name:

DONATION
$
(do not enter $ sign in the box)

PAYMENT INFORMATION

Card Holders Name (required)

Card Type (required)

Card Number (required)
(Numbers only, no dashes (-) or spaces

Expiration Date (required)

Security Code (required)

3 digits on back of your card, or 4 digits on the front for AMEX

PERSONAL INFORMATION

Prefix (required)

First Name (required)

Last Name (required)

Country (required)

Address 1 (required)

Address 2

City (required)

State/Province (required)

Zip/Postal Code (required)

Email (required)

Home Phone
This is my Primary Phone Number
xxx-xxx-xxxx

Mobile
This is my Primary Phone Number
xxx-xxx-xxxx

Please add/retain my e-mail address for future mailings.
(by unchecking this box you will not receive any emails from us.)

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