Catholic Women's Conference 2021 Registration if paying with check Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*ParishCity or Town where Parish is located*If you're purchasing multiple tickets, please list the names of those you will be buying tickets for in the box below.Catholic Women's Conference Registration Fee - $40.00 ($50.00 after June 9) Price: $40.00 Quantity: Virtual Ticket Price: $20.00 Quantity: Women Religious Ticket - No charge Price: $0.00 Quantity: Good Samaritan Ticket - $40 (I would like to purchase a ticket for a woman who can't afford to attend but would like her faith refreshed.) Price: $40.00 Quantity: Student Tickets (under 22 years of age) - $20 Price: $20.00 Quantity: Sponsorship OptionsPlease select one of the following options:Daisy: $100 (Recognition in the program and 1 seat.)Tulip: $250 (Recognition in the program and 2 tickets.)Lily: $500 (Recognition in the program and 4 reserved seats.)Rose: $1,000 (Recognition in the program and 6 reserved seats.)DonatePlease select from one of the following giving options:$25 Donation$50 Donation$100 Donation$250 DonationPlease make check payable to the Diocese of Scranton and mail to: Stephanie Westington Treasurer, Refresh Your Faith Conference P.O. Box 202 Dunmore, PA 18512Catholic Women's Conference Total $0.00
