Adult Catholic Catechism 2024-2025
Registrant Information
Full Name
*
First Name
Last Name
Phone Number
*
Email
*
Gender
*
Male
Female
Will you be registering your spouse as well?
*
Please Select
Yes
No
Registrant #2 Information
Name (Registrant#2)
*
First Name
Last Name
Phone Number (Registrant#2)
*
Gender (Registrant#2)
*
Male
Female
DOB (Registrant#2)
*
-
Month
-
Day
Year
Date
Email (Registrant#2)
*
example@example.com
EMERGENCY CONTACT INFORMATION
Emergency Contact
*
First Name
Last Name
Relationship to Registrant
*
Phone Number Of Person To Contact In Case Of Emergency
*
Please enter a valid phone number.
Email Of Person To Contact In Case Of Emergency
*
example@example.com
PAY ONLINE
Please check one of the following and proceed with your payment
prev
next
( X )
ACC-MYA Member
for 1 member only
$
75.00
ACC-1 Registrant
for 1 adult only
$
150.00
ACC- Couple Registration
for 2 adults only
$
250.00
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
PAY & SUBMIT
Should be Empty: