Annual Memorial Candles Form – The National Shrine of Our Lady of Czestochowa

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email *

Please keep a votive light burning for: *

1 Year

Suggested donation for the annual votive candle with metal engraved plaque is $250

Write text for SMALL PLAQUE. A small plaque which is displayed below the candle with the name of your loved one can contain only 51 characters. Maximum 3 lines - 17 characters per line *

Offering Amount (Annual Memorial Candles) *

$250
Other

Offering Amount (Annual Memorial Candles Request)

All donations made to the Shrine must be in USD.
Wszystkie ofiary składane na Sanktuarium muszą być w walucie amerykańskiej (w dolarach - USD). Prosimy również o nie tłumaczenie tej formy w translatorach internetowych, w razie jakichkolwiek pytań albo potrzebnej pomocy prosimy o zwracanie się bezpośrednio do naszego biura, wysyłając do nas emaila.

Total (Annual Memorial Candles Request)

$ 0.00

Stripe Credit Card *

Card

Name on Card

CONTACT US

Annual Votive Candle Form

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