PROGRAM REGISTRATION FORM

Please complete the form on - line or ...
if you would like to register by mail, print a copy of the completed form
and mail to the address below to register for a program(s). 

 On-Line Registration:

Click on the Register Now button below, complete contact, event and charge card information on our secure transmittal system.

      I have read Mercy Prayer Center Financial Policy and understand the terms

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By Mail Registration:

Contact Information:

   First Name: Last Name:
   Address:      Apt:
   City:         State:  Zip:
   Phone:      
   Email:      
           

 Program Information:

           
        
        
        
        
               Program                    Date            Cost 

Send completed form and check to:       

 Mercy Prayer Center
65 Highland Ave.
Rochester, NY 14620