ICC Women's Cornerstone Registration
Saturday, March 30, 2019 - One Day Experience
Email address *
First Name *
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Last Name *
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Street Address *
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City *
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State *
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Zip Code *
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Cell Phone (use dashes) *
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Home Phone (use dashes)
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Dietary Needs
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Parish Information (Check all that apply) *
Required
How did you hear about Women's Cornerstone? *
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Emergency Contact (last name first) *
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Relationship
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Emergency contact's email (must differ from yours) *
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Emergency contact's cell phone number (must differ from yours, use dashes) *
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Emergency contact's work number (use dashes)
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Emergency contact's home number (use dashes)
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Questions/Comments
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Donations of any amount are gratefully accepted and confidentially collected. (Suggested amount is $65). Bring your donation to the Experience (checks payable to ICC Women's Cornerstone). You may also mail the donation "Att: Women's Cornerstone" to Immaculate Conception Church or drop it in the Women's Cornerstone box in the church's narthex.
When you have successfully submitted your form, you will see a message of “Success” pop-up. If the form won’t “submit,” you have likely missed a required field which will be highlighted in red across the page. If you continue to have trouble please click on this email and let us know. WCICC97@gmail.com.
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