| Item |
Price
Each |
Quantity |
Total |
| Votive
Candle |
$5.00
|
|
$ |
| Devotional
Candle for Blessed Mother and St. Anne's Chapels |
$15.00
|
|
$ |
| Special
Intention in Memorial Book* |
$10.00
|
|
$ |
| Annual
Mother's Enrollment** |
$100.00
|
|
$ |
Total
Mother's Memorials
|
$ |
*Special
Intention. My special intention: (please
print or write legibly) ________________________________________________________________________________________
_________________________________________________________________________________________
**Annual Mother’s Enrollment - 52 weeks
of prayer for your mother or grandmother, living or deceased.
Your mother's name: _____________________________________________________________________
Birth Date (Optional): _____________________________________________________________________
Death Anniversary (Optional): _____________________________________________________________
Donations for Mothers
Outreach Mentoring Service (MOMS)
Enclosed is my offering of $__________________ to help the Shrine’s
outreach to mothers in need.
Donations for the Shrine Restoration Project
Enclosed is my offering of $__________________ to help restore
the Shrine to its original beauty and make the necessary capital improvements.
Name: ___________________________________________________________________________________
Address: _________________________________________________________________________________
City: ________________________________________ State: ________________
Zip: _________________
Telephone: (Optional) ____________________________________________________________________
Do you want to be on the Shrine's mailing list? _______ Yes _______
No
Do you want to be on the Shrine's email list? _______ Yes _______
No
Email address: ____________________________________________________________________________
Mail this form with
your check to:
The Shrine of Saint Anne
515 South Main Street
Waterbury, CT 06706
Thank you for your support.
© The
Shrine of Saint Anne · 515 South Main Street · Waterbury,
CT 06706 USA · 203-756-4439
