Diocese of Belleville, IL

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

Title: Hearts Aflame - Celebrating Couples Married Ten Years or Less

Date: March 7, 2026

Location: Corpus Christi Catholic Church, 205 Rasp St., Shiloh, IL

Cost: $50 per couple
Includes dinner, drinks, presentation, dance instruction and babysitting

Schedule:
Mass (optional): 4:30 pm
Cocktails: 5:30 pm
Dinner: 6:15 pm
Presentation: 7:00 pm
Dance: 8:00-10:00 pm

Qty

Description

Amount

Total

Registration

$50.00

(per couple)

Total: $50.00

Registrant Information

Name of Husband: *

Name of Wife: *

Parish: *

E-mail Address: *

Cell Phone Number: *

Babysitting requested?

Names and ages of children, allergies.

Payer 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.

Comments/Questions:

Your Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *