Please complete the following application to help us get the Adoration Manager Service prepared for your Adoration Chapel.

Your Name This is the name of the person completing the questionnaire so we know who to ask for during the followup.

Your Email Address

Your Callback Number

Your Chapel Name This is the full, official name of your chapel as it would be printed on official correspondence.

Host Church or Deanery Usually an adoration chapel resides on the premises and under the auspices of a host church. If your chapel fits this description, please complete this field.

Parish/Chapel Contact Information:

Street:

City: State: AlaskaAlabamaArkansasArizonaCaliforniaColoradoConnecticutDisctrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexaUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming Zipcode:

Phone:

Fax:

Email Address:

Have you started adoration already? Yes   No

When will you begin adoration? If you haven't yet begun eucharistic adoration, please specify the date you plan to start.

How did you hear about Adoration Manager?    Please select one option Another Adoration Chapel Newspaper article Magazine article Internet Search Engine Other

Other (Please specify):

Reffering Chapel If another chapel referred you to us, please enter the name of the Chapel. If they are also using Adoration Manager, they may be eligible to receive an additional discount off their monthly service.

Adoration Phone Number This phone number will be printed in the Welcome Packet for adorers to use as a contact point for your adoration chapel.

Additional comments? Please note times you would prefer to be contacted and whether it be by email or phone. If you have any other comments please feel free to add them here.

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