Diocese of Springfield in Illinois

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Thank you for taking the time to register for the Spring Gathering of Priests. This form will help you register and pay your registration fee. If you are still needing to make your hotel reservation, please do so by calling the Crowne Plaza at (217) 529-7777. Please mention that you are with the Diocese of Springfield in Illinois.

Qty

Description

Amount

Total

Spring Gathering of Priests

$175.00

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Total: $0.00

Parish Information

Parish Name: *

Address: *

City: *

State: *

Zip Code: *

Phone Number: *

E-mail: *

Priest’s Registration Information

First Name: *

Last Name: *

E-mail: *

Phone Number: *

Mailing Address:

Please supply your mailing address if different from the parish's.

Billing Information

First Name: *

Last Name: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Telephone:

E-mail: *

A receipt will be e-mailed to this address.

Your Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *

Name on Account: *

Routing Number: *

Account Number: *