Christmas Lighting Dedications Enrollment Form

Please print this form and mail the completed form and donation to:
Mount Alvernia Retreat Center
Christmas Lighting
P.O. Box 858
Wappingers Falls, N.Y. 12590

A donation of $10.00 is requested for each person remembered to help defray the cost of the lights.

Your Name_________________________________________________________

Address___________________________________________________________

Address___________________________________________________________

Phone___________________________
 

Please light in honor or memory of:
 

Name:_____________________________________________________________

Name:_____________________________________________________________

Name:_____________________________________________________________

Name:_____________________________________________________________

Name:_____________________________________________________________

Name:_____________________________________________________________

Name:_____________________________________________________________

Name:_____________________________________________________________

Name:_____________________________________________________________