2021 ST LOUIS MARIAN CONFERENCE - Registration Form

PRINT THIS FORM AND FILL OUT COMPLETELY

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 @ $50 ($60 after 4/17)................................$_______

#_____Youth (12-20) @ $25 ($30 after 4/17)....................$_______

#_____ Total Registering /  TOTAL AMOUNT Enclosed $_______

#_____Professed Priests;  #_____Nuns;   #_____Seminarians.........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

*Mail this form with check or money order to:
St. Louis Marian Conference
520 Mothershead Ridge Rd
De Soto, MO 63020

(    ) VISA        (    ) MC     (    ) DISCOVER

Account Number ______________________________    Exp. Date ______ /_______

CIN No.  _______ (3-digit code found on back of card)

Billing Address__________________________________________________________

Name on Card____________________________    Signature______________________________

***Registration fees are non-refundable.***
We will send an email confirmation only, so please include your email address when registering!
Name badges for the 2021 conference may be picked up when you arrive.


Face masks and social distancing required at all times.