Interest Survey for Perpetual Adoration

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First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Email REQUIRED Please fill out this field. Please enter an email address.
I prefer that you contact me via (check all that apply): REQUIRED Email Phone Call Text Please fill out this field.
Please check which time(s) / day(s) you prefer (or please feel free to list a specific hour): REQUIRED Morning (6 am to Noon) Afternoon (Noon to 6pm) Evening (6pm to 12 midnight) Night (12 midnight to 6am) Specific hour requested... Please fill out this field.
Specific hour requested: Please enter valid data.
Preferred Day(s) REQUIRED Monday Tuesday Wednesday Thursday Friday Saturday Sunday Please fill out this field.
Are you interested in helping coordinate Perpetual Adoration? REQUIRED Yes No Please fill out this field.

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St. Margaret Mary Catholic Church