Diocese of Springfield in Illinois

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STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

As Catholics, we believe that all life is sacred. Participating in the March for life is an opportunity to be advocates for those who cannot speak for themselves and to help our government understand why we believe life is so sacred.

Please use the following form to initiate registration for the March for Life. This form helps us identify who each group leader is and will help us forecast the number of pilgrims expected for the trip. You can use this form to reserve space on the trip at the early registration price of $325.00 even if you are not sure who specifically wants to participate. A non-refundable deposit of $100.00 per person will be billed with this form. The deposit is transferable.

Qty

Description

Amount

Total

March For Life Deposit

$100.00

---

each attendee

Total: $0.00

Group Information

Group Leader:

Group Name:

Address:

City/Zip:

Day Phone:

Evening Phone:

Parish/School:

Email Address:

Pilgrimage Choice:

Group Attendance Breakdown

(Note: Numbers reported here can be estimates to secure early registration prices)

Female Youth:

(6th – 12th Grade Students)

Male Youth:

(6th – 12th Grade Students)

Female Young Adults:

(ages 18-20 and out of high school)

Male Young Adults:

(ages 18-20 and out of high school)

Female Adults:

(21 and older)

Male Adults:

(21 and older)

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: *