| First Name: | |
| Last Name: | |
| Address Street 1: | |
| Address Street 2: | |
| City: | |
| Zip Code: | (5 digits) |
| State: | |
| Daytime Phone: | |
| Evening Phone: | |
| Email: | |
| Volunteer Opportunities: | |
| Social Committee: | I would like to help with the weekly socials (every Tues, 3-4pm) |
| | I will be available at Chautauqua to help (Please list dates available below) |
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| Liturgy Committee: | I am a Eucharistic Minister at my home parish and would be willing to serve as a Eucharistic Minister at Chautauqua. For ease of scheduling please indicate above your weeks of attendance. |
| | I am a Lector at my home parish and would be willing to serve as a Lector at Chautauqua. For ease of scheduling please indicate above your weeks of attendance. |
| Memorial Mass: | Please include the following names for remembrance at the opening Masses (Please list names in the box below). |
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