Oregon and SW Washington Episcopal Cursillo
Electronic version of "Oregon and SW Washington Episcopal Cursillo Database" form
Email address *
Contact Information
First Name *
Last Name *
Name on ID, if different
Gender
Clear selection
Street Address
City *
State *
Zip
Cell Phone
Other Phone
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Year of Birth
If Ordained, Year of Ordination
Home Parish/Church
City/State of Home Parish/Church
Year first attended Cursillo
Diocese where first attended Cursillo
Emergency Contact Name (and Relationship)
Emergency Contact Phone
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