Light of the World Online Registration

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First Name

Last Name

Preferred Name for Name Tag (if different than first name)

Street Address

Street Address Line 2

City

Region/State

Postal / Zip code

Phone

Email

May we text you? (By saying YES, please be aware Msg and data rates may apply) * Required

Yes

No

You must be 18 years old to attend. Are you 18 or older? * Required

Yes

No

Nativity of Our Lord, 510 Richard A Mautino Dr., P.O. Box 150 Spring Valley, IL 61362

Tel: 815-663-3731

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