Caritas Directory of Practitioners Submission Form
(PAYPAL PAYMENT BUTTON is located just below submit button)
Name *
(Last, First)
Occupation *
Contact Phone *
(this will be the number used as contact info in your directory listing)
Contact Email *
(this will be the email used as contact info in your directory listing)
Website
Please Describe Your Service(s) *
Please limit to 150 words or less. Longer submissions will be shortened.
Please Select One Of The Following: *
Image To Be Used In Directory
Clear selection
Date You'd Prefer Your Listing To Start *
The online directory is updated every wednesday, while the Events Bulletin is emailed out every two weeks
MM
/
DD
/
YYYY
Are You On Facebook? *
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