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Cler
g
y Registrati
o
n Form
Clergy Registration will open on January 12th
Name
*
Fr.
Msgr.
Dcn.
Bishop
Arch Bishop
Prefix
First
Last
Registration Type
*
Priest
Deacon
Steubenville Location
*
Lone Star
Florida
Atlanta
West
East
San Diego
Diocese
*
Order (if applicable)
Parish Name
*
Parish City & State
*
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Email
*
Parish Phone
*
Cell Phone
*
Would you like a secretary, assistant, or youth minister to be copied on correspondence with you regarding the conference?
*
Yes
No
Name of secretary/assistant/youth minister
*
First
Last
Email address of secretary/assistant/youth minister
*
Are you coming with a registered parish group?
*
Yes
No
Group Leader Name
*
First
Last
Group Parish Name
*
Group City & State
*
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Will you be attending for the full weekend?
*
Yes
No
Please tell us anything else we should know about your attendance at the conference.
Email
This field is for validation purposes and should be left unchanged.
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Media Kit
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