Form Test 5 - Emmaus Ministry For Grieving Parents

EMFGP Template: Gathering with Optional Donation

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REGISTRATION INFORMATION

If you have any problems completing this form, please email [email protected].

Parent Name 1(Required)

First Last

Registration Selection(Required)

Parent Name 2

First Last

Email(Required)

Phone(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

RECORDING

Yes

Parts of this retreat that do not include personal interactions, will be recorded, so that we can offer it virtually to other parents via the Emmaus website. Do you understand this?

FREE WILL OFFERING (OPTIONAL)

Your optional donation will be used to help offset our costs of providing this retreat. Any donation of any amount is deeply appreciated, but not necessary.

Donation Amount

Total

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Stripe Total

Credit Card

Card Details

Cardholder Name

This field is for validation purposes and should be left unchanged.