Office of Radio & Television - Prayer/Intention Donation Form

Office of Radio & Television - Prayer/Intention Request Form

For your convenience we have provided you with this Prayer/Intention Request Form. Please print this form by clicking the printer icon in your browser's navigation bar, complete it and mail it together with your donation to: Office of Radio & Television, 15 Peach Orchard Road, Prospect, CT 06712-1052. If you are unable to print this form please include this information in a note with your donation. Thank you.

The Celebration of the Eucharist is broadcast 7 Days a Week
at 10 a.m. on WCCT-TV The CW20.

Dear Fr. John,

I wish to make the following sacrifice to help keep the Mass on television.

[ ] $10 [ ] $15 [ ] $25 [ ] $50 [ ] $75 [ ] $100 [ ] $250 [ ] Other $_______

For your convenience you may make your donation by check/money order or credit card.

Donation Information:

[   ] Check/Money Order (made payable to the Office of Radio & Television)

[   ] American Express

[   ]   Discover Card

[   ]   MasterCard

[   ]   Visa

^{Account Number:}

^{Exp. Date:}

^{Cardholder's Signature:}

^{Security Code (3 or 4 digits):}

PLEASE PRINT AND INDICATE WHETHER LIVING OR DECEASED

Please pray for my special intention (name):

_______________________________________________________________________

[ ] Living [ ] Deceased

Donor Information:

^Name:

^Telephone:

^Address:

^City:

^State:

^{Zip Code:}

Please mail this completed form together with your donation to:

Office of Radio & Television
15 Peach Orchard Road
Prospect, CT 06712-1052

Telephone (203) 758-7367

It may take up to TWO months before your request appears on the television Mass. However, I will personally pray for your intentions as soon as I receive them. Thank you for supporting the television Mass and Bringing Good News to Life!

Have a Rainbow Day,

^{Account Number:}	^{Exp. Date:}
^{Cardholder's Signature:}	^{Security Code (3 or 4 digits):}