Mass Request Form - Fill out Form, click "Print Me" and send with $10.00 Stipend to: National Shrine of Our Lady of Lebanon 2759 North Lipkey Rd - North Jackson, Ohio 44451 - ** Stipend: A $10.00 Donation is the Norm** Phone: 330-538-3351
Mass Request For (Intention)
Living or Deceased
Select One
Living
Deceased
Send Card (Yes or No)
Select One
Yes
No
Send Card To (Address)
From (Benefactor)
Benefactor's Address
Benefactor's Phone #
