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Registration Form

Wedding Anniversary Celebration 2018
If you are submitting late registrations please let Beth know (beth.ulaszek@madisondiocese.org or 608-821-3026) so that late registrations do not get overlooked or forgotten. Thank you so much and God bless!
-Beth
Registration Form
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- Husband
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Wife
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Wedding Year REQUIRED Please fill out this field. Please enter an integer (number).
- Current Parish REQUIRED Please fill out this field. Please enter valid data.
- Contact Information
- Mailing 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.
- Phone Number Please enter a phone number.
- Email Please enter an email address.
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Wedding Anniversary Celebration 2018