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* 1. Parish Name

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* 2. Parish City

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* 3. Pastor / Parochial Administrator

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* 4. Contact Name, if different from Pastor

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* 5. Phone Number

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* 6. Email Address

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* 7. CCA In-pew and speaker weekend will take place during the following weekends, Please select one of the following dates for a speaker to attend:

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* 8. If you are interested in a speaker but unable to accommodate the above dates, please list an alternate date.

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* 9. Please list your weekend Mass times (please list both Saturday and Sunday times):

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* 10. Is there someone you would like to speak at your parish? Please let us know:

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* 11. Would you like an Appeal poster(s) mailed to your parish?

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* 12. Please provide the name of the individual who will serve as your CCA Parish Ambassador below. See enclosed document for additional details.

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