St. Dominic's Benefactor Enrollment Order Form

PRINT name of person (s) to be enrolled:  ________________________________________________

Person is: ____deceased     _____living

Enrollment:   One Month         One Year        Perpetual

Please Briefly describe any specific prayer petitions: ______________________________________________  ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________

Should we send the card to you to present personally? _____YES

OR, should we fill out the card and mail it to the recipient for you? _____YES

Please tell us how you would like the card signed,

"From ________________________________" 

Please mail the card TO (please print clearly):

Name: _______________________________________

Address: _____________________________________

              _____________________________________

City: ________________________________________

State: ________________   Zip: __________________

 

Enrolled by (please print clearly):

Name: _______________________________________

Address: _____________________________________

              _____________________________________

City: ________________________________________

State: ________________   Zip: __________________

Phone: ______________________________________

Email: _______________________________________

 

Customary offerings:

One Month Enrollment: $5 ($3 + $2 SH).

All one-year enrollments: $15 ($13 + $2 SH).

Perpetual Enrollment: Individual $25 ($23 + $2 SH, Family $35 ($33 + $2 SH) 

 

Please enclose check or money order made payable to: Willing Shepherds of Jesus Christ Chapter

Send to:

Third Order of Penance of St. Dominic

Willing Shepherds of Jesus Christ Chapter

321 South Broadway

Lawrence, MA 01843

USA


Tel: (978) 686-7921

To Print: Press Control All (Ctrl + A) and then Print, send in Request at provided address with check or money order.

You will receive St. Dominic's Rosary Enrollment certificate within 2 weeks