Mass Card Request (click on particular card you need and complete form below)

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Street Address and Number REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

I would like Mass celebrated for the following: Mass for someone that has died Mass for someone that is living Mass for a Special Intention (anonymous) Mass for a Special Intention (specific) I would like to request a specific date and time of Mass

Weekday Monday at 12:05pm Tuesday at 12:05pm Wednesday at 12:05pm Thursday at 12:05pm Friday at 12:05pm

Weekend Mass Saturday at 5:00pm Sunday at 8:00am Sunday at 9:30am Sunday at 11:30am

Name of Deceased/Living/Special Intention

Mass Request by: Please enter valid data.

Delivery of Mass Card I will come and pick it up at the Parish Center (at 22Halsted Street) Please mail it directly to me (address below) Please mail it directly to someone else (address below)

Name and Address for Mass Card to be mailed

Mass Card Request (click on particular card you need and complete form below)

ADDRESSES/PHONE

Father Michael J. Burke
THRIFT SHOP

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