Birthday Blessings Enrollment

* required information
Birthday Blessings Enrollment 
Contact Information
First Name:*
Last Name:*
Address Line 1:*
Address Line 2:
City:*
State:*
Province:
ZIP/Postal Code:*
Country:
Phone:
Email:*
Additional Information
Please enroll the following persons in the Birthday Remembrance Mass celebrated every second Saturday at the National Shrine:*
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