Diocese of Scranton      Office for Parish Life

Developing a FamilyWise Parish Registration Form

Please Provide Us With The Following Information:

First Name
Last Name
Address	(ex. 123 Main St)
City
State
Zip Code
Phone
E-Mail	(ex. Sarah@aol.com)
Parish
City
Register	$160/person $320/three from same parish Number of Persons One Two Three $75/fourth and successive persons from same parish Number of Persons Four Five Six
Payment	Enclosed Bill My Parish PFI Grant      Please make check payable to:     Diocese of Scranton