Life Advocacy Day Registration
Please make checks payable to "St. Mary Parish" and drop off at the parish office.
First & Last Name *
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Address *
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City, State, Zip *
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Email Address *
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Cell Phone Number *
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By clicking the box below you agree that on behalf of yourself, your heirs, assigns, executors and personal representatives, to hold harmless and defend the Diocese of Joliet, St. Mary Parish, it's officers, directors, agents, employees, or representatives form any and all liability for illness or death arising from or in connection with your participation in this trip. In event that you should require medical treatment and you are not able to communicate your desires to attending physicians or other medical personal, you give permission for the necessary emergency treatment to be administered. I understand that I or my insurance company will be responsible for any charges incurred. *
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