Mass Membership Form -Annual=$10.00...Perpetual=$35.00 - Please fill out form, click "Print Me" and send with Stipend to National Shrine of Our Lady of Lebanon - 2759 North Lipkey Rd - North Jackson, Ohio 44451 - Phone...330-538-3351
Type of Membership
Select One
Annual $10.00
Perpetual $35.00
For (Intention)
Living or Deceased
Select One
Living
Deceased
Send Card
Select One
Yes
No
Send Card To (Address)
Address of Benefactor
Phone # of Benefactor
Mass Membership Form
