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Where do you primarily attend Mass? REQUIRED St. Ignatius of Loyola (Mt. Horeb) Holy Redeemer (Perry) Immaculate Conception (Barneveld) St. Bridget (Ridgeway) St. Patrick (Hollandale) Immaculate Conception (Blanchardville) Please fill out this field.

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Street Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Full Mailing Address (if different from above)

Primary Email REQUIRED Please fill out this field. Please enter an email address.

Primary Phone Number REQUIRED

Please fill out this field. Please enter a phone number.

I would like to receive giving envelopes REQUIRED Yes No Please fill out this field.

I would like to learn more about the Catholic faith REQUIRED Yes No Please fill out this field.

Please list any other family members or notes you would like us to know. REQUIRED Please fill out this field.

A parish representative will reach out to welcome you and gather other registration information. Is there a day or time to best contact you? REQUIRED Please fill out this field.

ST. FRANCIS OF ASSISI PARISH

MT. HOREB, BARNEVELD, HOLLANDALE, Perry, Ridgeway & BLANCHARDVILLE

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