Catholic Women's Conference 2023 Registration if paying with check Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Parish City 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 - $55.00 Quantity Price: $55.00 Quantity Women Religious Ticket - No charge Quantity Price: $0.00 Quantity Good Samaritan Ticket - $55 (I would like to purchase a ticket for a woman who can't afford to attend but would like her faith refreshed.) Quantity Price: $55.00 Quantity Student Tickets (under 22 years of age) - $20 Quantity 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 DonationDo you have any dietary restrictions? Yes No Please 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
