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PARISHIONER REQUEST EASTER GIFT CARD ASSISTANCE

Any parishioners who are in need and a few gift cards can help you through the Easter season, please provide the information requested below. Any information we receive will be held in the strictest confidence.
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- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Street Address REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Number of Adults in the Household REQUIRED Please fill out this field. Please enter an integer (number).
- Number of Children in the Household REQUIRED Please fill out this field. Please enter an integer (number).
- Any other information you would like to include: REQUIRED Please fill out this field.
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