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Annual & Solemn Enrollments

- Giving

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- Enrollment Suggested Donation
  15.0 – Annual Enrollment
  25.0 – Solemn Enrollment
- Other Donation Amount $ Please enter a positive decimal.
- Person Enrolled REQUIRED
  This name will appear on the certificate.
  Please fill out this field. Please enter valid data.
- Please make the appropriate selection for the person enrolled. REQUIRED Please fill out this field.
- Enrollment Requested By:
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Phone Number Maximum 20 characters Please enter a phone number.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Address Please enter valid data.
- City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
- Optional Message Maximum 25 characters
  (maximum 25 characters including spaces)
  Please enter valid data.
- Mail Certificate To:
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Address REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Please note that our credit card processor automatically bounces multiple charges within a two hour time frame. If you wish to donate for multiple enrollments please charge the total amount and call our Provincial Office at 504-837-2129 to share who you would like the enrollments to go to.
Total:

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