Mass Request Form

Please provide the following:

Name of Person whom you wish to have Mass offered. Living or Deceased.__________________________________________________

Date you wish to have Mass offered._____________________________

Mass being requested by:

Name_____________________________________________________

Address_______________________, City,________ State,_____ Zip_____

Email and/or Phone ___________________

Your Tax Deductible donation for a Mass of $10.00

Please make Check or Money Order Payable to the Evangelical Catholic Church

11045 South Avenue G Chicago Illinois 60617 773-721-5383

or

you may choose to use

“A Welcoming Community of Faith Rooted in the Catholic Tradition”