CURSILLO.INC – Secure Payment Form

First Name *

Last Name *

Street Address *

City *

State/Province *

Zip Code *

Country *

Name of Church *

Email Address *

Telephone Number *

Donation Amount

$12
$25
$50
$75
$100
Other

Donation Frequency

This is a single, one-time donation.

Repeat this same donation once a year, beginning in 365 days.

Prayer Chain AgreementBy checking this box I agree to join the prayer chain and that my first initial, last name, and parish is to be displayed in the prayer chain for my $12 or more annual donation. If the box is not checked I understand that I am not joining the prayer chain and am only making a donation.

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