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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. I request one of the following speakers

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* 8. Who would you like to request to speak at your parish, if applicable?

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* 9. I prefer the speaker be assigned for the weekend of:

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* 10. Will you provide overnight accomodations for a seminarian?

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* 11. If your parish offers Mass in a language other than English, please list below:

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* 12. Our weekend Mass times are (please list both Saturday and Sunday times):

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* 13. Additional Notes / Comments

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