Second Annual Valentine&#039;s Dinner

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Name of Late Spouse REQUIRED Please fill out this field. Please enter valid data.

Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Confirmation Email REQUIRED Please fill out this field. Please enter an email address.

Church Parish REQUIRED Our Lady of the Most Holy Rosary Parish Other (Please list below) Please fill out this field.

Church Parish Please enter valid data.

Did you attend our Valentine's Event last year? REQUIRED Yes No Please fill out this field.

Please select your preference for each option below:

Dressing for Salad REQUIRED Italian Honey Mustard Ranch No Dressing Please fill out this field.

Protein for Fettuccine REQUIRED Chicken Shrimp Please fill out this field.

Topping for Cheesecake REQUIRED Chocolate Strawberry Plain - No Topping Please fill out this field.

Wine Preference REQUIRED Red White Water Only Please fill out this field.

Reservation Fee REQUIRED Please fill out this field.

Our Lady of the Most Holy Rosary