2017 MARIAN CONFERENCE - Registration Form

Name ______________________________________________________________________

Address _____________________________________________________________________

City/State/Zip Code ____________________________________________________________

E-mail ______________________________________________________________________

Phone # (       ) ____________________________________

Name of Parish ______________________________ Diocese ___________________________

If registering more than one person, please list names on reverse side.

#_____Adults @ $35 ($40 after 12/31)....................$______

#_____Young Adults (12-25) @ $15........................$______

#_____Children (5-11) @ $5...................................$______

#_____Family Rate (same household) @ $80............$______

#_____GROUP RATE  (8 or more) @ $30 ea. ($25 ea. prior to 12/31)..................$_______

#_____ Total Registering /  TOTAL AMOUNT Enclosed   $_______

#_____Priests;  #_____Vowed Religious;   #_____Deacons.........NO CHARGE

I am a priest and I wish to Concelebrate Mass:  (   ) Friday   (   )  Saturday   (   ) Sunday
Hear Confessions:   (   ) Friday  (   ) Saturday  (   )  Sunday
I am a Deacon and I wish to assist at Mass:  (   )  Friday   (   ) Saturday   (   )  Sunday

*Make checks or money order payable to:
St. Louis Marian Conference
8015 Monroe Street
Saint Louis, Missouri 63114
 (314) 423-1075 fax (314) 423-9973

(    ) VISA        (    ) MC     (    ) DISCOVER

Account Number ______________________________    Exp. Date ______ /_______

CIN No.  _______ (back of card last 3 numbers)

Name on Card____________________________    Signature______________________________

*(Registration fees are non-refundable.  Badges will be mailed prior to the Conference).