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Parish Information
Parish Name :
Diocese :
# of Families (approx) :
Phone :
Website :
Address 1 :
Address 2 :
City :
State :   
Zip/Post Code :
Country :   
   
Pastor/Clergy Information
( Who will be part of DTS leadership )
First Name :
Last Name :
Phone :
Email :
Confirm Email :
   
Youth Minister Information
( If you do not have a Youth Minister please skip this section )
First Name :
Last Name :
Phone :
Email :
Confirm Email :
Address 1 :
Address 2 :
City :
State :
Postal Code :
Country :
   
Comment :
Chapter Leader Information
First Name :
Last Name :
Phone : * ex. 1235551234 - no dashes or periods please
Fax : * ex. 1235551234 - no dashes or periods please
Email :
Address 1 :
Address 2 :
City :
State :   
Zip/Post Code :
Country :   
   
    
 
 
If you have any Comments or Questions please contact Eddie Cotter, Jr.:
eddie@DeadTheologiansSociety.com