Member Info

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Member Info

Email *

Salutation *

First Name *

Please enter first name in Title Case (eg John, Mary Ann)

Last Name *

Please enter last name in Title Case (eg. Lee, D'Silva, McDonald)

Street Address *

Please enter street name in TItle Case (eg. Main St)

City *

Please enter using Title Case

Chilliwack

Coquitlam

Maple Ridge

Pitt Meadows

Port Coquitlam

Surrey

Other:

Province / State *

NOTE: For Canada/USA: Please use abbreviations

Other:

Country *

Canada

USA

Other:

Postal Code / ZIP Code *

Please use a space between: eg. V1H 2J2

Home Phone

NOTE:

Cell Phone

NOTE:

Name of Your Parish (followed by city) *

Our Lady of the Assumption, Port Coquitlam

Star of the Sea, Surrey

St. Clare of Assisi, Coquitlam

St. Luke's, Maple Ridge

St. Mary's, Chilliwack

Sacred Heart, Terrace

Other:

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