Lighting Dedications Enrollment Form

Please print this form and mail the completed form and check to:
Mount Alvernia, P.O. Box 858, Wappingers Falls, N.Y. 12590

Enclosed is a check payable to Mount Alvernia Retreat Center with your contribution.

Your Name_________________________________________________________
 

Address___________________________________________________________
 

Address___________________________________________________________
 

Phone___________________________
 

Please light in honor or memory of:
 

name:_____________________________________________________________
 

name:_____________________________________________________________
 

name:_____________________________________________________________
 

name:_____________________________________________________________
 

name:_____________________________________________________________
 

name:_____________________________________________________________
 

name:_____________________________________________________________
 

name:_____________________________________________________________
 

name:_____________________________________________________________