Immaculate Conception
Catholic Church

Houston, TX - Archdiocese of Galveston-Houston

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Mass Intention Form

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- I am requesting REQUIRED A Mass Intention A Health/Well-Being Intention Anniversay Intention Birthday Intention Please fill out this field.
- I am a Member of Immaculate Conception Catholic Church REQUIRED Yes No Please fill out this field.
- Member Number Please enter valid data.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Email Please enter an email address.
- Cell/Home Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Mass Intention(s)
- Date of Intention REQUIRED 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.
- Please indicate REQUIRED Living Deceased Please fill out this field.
- Special Comments or Instructions regarding Intention(s) Please enter valid data.
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