Name *

First Name

Last Name

Phone *

(###)

###

####

Name of Priest or Seminarian *

First Name

Last Name

Address of Priest or Seminarian *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Shipping Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Package Policy *

We only send one Self-Care Package to a priest or seminarian so that he does not receive duplicates. If your intended priest or seminarian has already received a Self-Care Package, the package you have chosen will be sent to another priest or seminarian who has requested one. Please check the box to indicate you accept these terms.

I accept and understand that my package may be sent to another recipient if my intended recipient has already received one.