Today's Date * +

Bride's Information

Bride's Full Name *

Bride's Date of Birth * +

Bride's Street Address *

City *

State *

Zip Code *

Bride's Phone Number *

Bride's Alternate Phone Number

Bride's Email Address *

Re-enter email address *

Religion of Bride *

Parish (name, city, state)

Has the Bride been Baptized? *

Where? (parish name, city, state) *

Has the Bride been Confirmed? *

Where? (parish name, city, state) *

Has the Bride been married previously? *

Groom's Information

Groom's Full Name *

Groom's Date of Birth * +

Groom's Street Address *

City *

State *

Zip Code *

Groom's Phone Number *

Groom's Alternate Phone Number

Groom's Email Address *

Re-enter email address *

Religion of Groom *

Parish (name, city, state)

Has the Groom been Baptized? *

Where? (parish name, city, state) *

Has the Groom been Confirmed? *

Where? (parish name, city, state) *

Has the Groom been married previously? *

Date requested for wedding

Will you be inviting a guest priest to preside at your wedding? *

If you are inviting a visiting priest to preside at your wedding, please provide his name and parish, including the city and state of the parish. *

We are interested in becoming active, registered members of Divine Mercy Catholic Church.

Yes

No

We are already active registered members.

Special Notes of Interests or Questions You May Have

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