Secure Online Gift Commitment Form
$
CASTILIAN ROSES: Up to $499 /
Your name and personal intentions will be remembered at our special Feast Day Mass of Our Lady of Guadalupe on December 12th of this year.
$
AM I NOT HERE, YOUR MOTHER?: $500 - $999 /
Your name and personal intentions will be remembered at our Feast Day Mass of Our Lady of Guadalupe on December 12th of this year. In addition, we will light a memorial candle in your name or the name of a loved one for three months at the new Our Lady of Guadalupe Altar.
$
THE MOUNTAIN OF TEPEYAC: $1,000 - $2,499 /
In memory of a loved one, a commemorative plaque will be added within the "Hill of Tepeyac" mural. Your name and personal intentions will be remembered at our Feast Day Mass of Our Lady of Guadalupe on December 12th of this year. In addition, we will light a memorial candle in your name or the name of a loved one for six months at the new Our Lady of Guadalupe Altar.
$
ST JUAN DIEGO: $2,500 - $4,999 /
You will be honored on a commemorative plaque on the original artwork of Our Lady of Guadalupe painted for the restoration of the shrine. Your name and personal intentions will be remembered at our Feast Day Mass of Our Lady of Guadalupe on December 12th of this year. In addition, we will light a memorial candle in your name or the name of a loved one for one year at the new Our Lady of Guadalupe Altar.
$
QUEEN OF THE AMERICAS: $5,000 or more /
You will be honored on a commemorative plaque on the Candle Stand in the shrine of Our Lady of Guadalupe. Your name and personal intentions will be announced at our Feast Day Mass of Our Lady of Guadalupe on December 12th of this year. In addition, we will light a perpetual memorial candle in your name or the name of a loved one at the new Our Lady of Guadalupe Altar.
Name for Memorial Candle or Commemorative Plaque:
Total Amount: $
0.00
(U.S. Currency)
Prayer Intentions:
500
characters left
Payment Options
*
Credit Card or Check/
Debit Card
Bank Account Transfer
(ACH)
Card Number
Security Code
(CVV2)
Expiration Date
1 - January
2 - February
3 - March
4 - April
5 - May
6 - June
7 - July
8 - August
9 - September
10 - October
11 - November
12 - December
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
Account Type
(U.S. Banks Only)
Checking
Savings
Account Number
Routing Number
Your Information
First Name
*
Last Name
*
Billing Address
*
City
*
State
*
AL
AK
AS
AA
AE
AP
AZ
AR
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
Zip
*
Province
Postal Code
Country
AFGHANISTAN
ALAND ISLANDS
ALBANIA
ALGERIA
AMERICAN SAMOA
ANDORRA
ANGOLA
ANGUILLA
ANTARCTICA
ANTIGUA AND BARBUDA
ARGENTINA
ARMENIA
ARUBA
AUSTRALIA
AUSTRIA
AZERBAIJAN
BAHAMAS
BAHRAIN
BANGLADESH
BARBADOS
BELARUS
BELGIUM
BELIZE
BENIN
BERMUDA
BHUTAN
BOLIVIA
BOSNIA AND HERZEGOVINA
BOTSWANA
BOUVET ISLAND
BRAZIL
BRITISH INDIAN OCEAN TERRITORY
BRUNEI DARUSSALAM
BULGARIA
BURKINA FASO
BURUNDI
CAMBODIA
CAMEROON
CANADA
CAPE VERDE
CAYMAN ISLANDS
CENTRAL AFRICAN REPUBLIC
CHAD
CHILE
CHINA
CHRISTMAS ISLAND
COCOS ISLANS
COLOMBIA
COMOROS
CONGO
CONGO, THE DEMOCRATIC REPUBLIC OF THE
COOK ISLANDS
COSTA RICA
COTE D'IVOIRE
CROATIA
CUBA
CYPRUS
CZECH REPUBLIC
DENMARK
DJIBOUTI
DOMINICA
DOMINICAN REPUBLIC
ECUADOR
EGYPT
EL SALVADOR
EQUATORIAL GUINEA
ERITREA
ESTONIA
ETHIOPIA
FALKLAND ISLANDS
FAROE ISLANDS
FIJI
FINLAND
FRANCE
FRENCH GUINEA
FRENCH POLYNESIA
FRENCH SOUTHERN TERRITORIES
GABON
GAMBIA
GEORGIA
GERMANY
GHANA
GIBRALTAR
GREECE
GREENLAND
GRENADA
GUADELOUPE
GUAM
GUATEMALA
GUERNSEY
GUINEA
GUINEA-BISSAU
GUYANA
HAITI
HEARD ISLAND AND MCDONALD ISLANDS
HOLY SEE (VATICAN CITY STATE)
HONDURAS
HONG KONG
HUNGARY
ICELAND
INDIA
INDONESIA
IRAN, ISLAMIC REPUBLIC OF
IRAQ
IRELAND
ISLE OF MAN
ISRAEL
ITALY
JAMACA
JAPAN
JERSEY
JORDAN
KAZAKHSTAN
KENYA
KIRIBATI
KOREA, DEMOCRATIC PEOPLE'S REPUBLIC OF
KOREA, REPUBLIC OF
KUWAIT
KYRGYZSTAN
LAO, PEOPLE'S DEMOCRATIC REPUBLIC
LATVIA
LEBANON
LESOTHO
LIBERIA
LIBYAN ARAB JAMAHIRIYA
LIECHTENSTEIN
LITHUANIA
LUXEMBOURG
MACAU
MACEDONIA, THE FORMER YUGOSLAV REPUBLIC OF
MADAGASCAR
MALAWI
MALAYSIA
MALDIVES
MALI
MALTA
MARSHALL ISLANDS
MARTINIQUE
MAURITANIA
MAURITIUS
MAYOTTE
MEXICO
MICRONESIA, FEDERATED STATES OF
MOLDOVA, REPUBLIC OF
MONACO
MONGOLIA
MONTENEGRO
MONTSERRAT
MOROCCO
MOZAMBIQUE
MYANMAR
NAMBIA
NAURU
NEPAL
NETHERLANDS
NETHERLANDS ANTILLES
NEW CALEDONIA
NEW ZEALAND
NICARAGUA
NIGER
NIGERIA
NIUE
NORFOLK ISLAND
NORTHERN MARIANA ISLANDS
NORWAY
OMAN
PAKISTAN
PALAU
PALESTINIAN TERRITORY
PANAMA
PAPUA NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
PITCAIRN
POLAND
PORTUGAL
PUERTO RICO
QATAR
REUNION
ROMANIA
RUSSIAN FEDERATION
RWANDA
SAINT BARTHELEMY
SAINT HELENA
SAINT KITTS AND NEVIS
SAINT LUCIA
SAINT MARTIN
SAINT PIERRE AND MIQUELON
SAINT VINCENT AND THE GRENADINES
SAMOA
SAN MARINO
SAO TOME AND PRINCIPE
SAUDI ARABIA
SENEGAL
SERBIA
SEYCHELLES
SIERRA LEONE
SINGAPORE
SLOVAKIA
SLOVENIA
SOLOMON ISLANDS
SOMALIA
SOUTH AFRICA
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS
SPAIN
SRI LANKA
SUDAN
SURINAME
SVALBARD AND JAN MAYEN
SWAZILAND
SWEDEN
SWITZERLAND
SYRIA
TAIWAN
TAJIKISTAN
TANZANIA, UNITED REPUBLIC OF
THAILAND
TIMOR-LESTE
TOGO
TOKELAU
TONGA
TRINIDAD AND TOBAGO
TUNISIA
TURKEY
TURKMENISTAN
TURKS AND CAICOS ISLANDS
TUVALU
UGANDA
UKRAINE
UNITED ARAB EMIRATES
UNITED KINGDOM
UNITED STATES MINOR OUTLYING ISLANDS
URUGUAY
USA
UZBEKISTAN
VANATU
VENEZUELA
VIET NAM
VIRGIN ISLANDS, BRITISH
VIRGIN ISLANDS, U.S.
WALLIS AND FUTUNA
WESTERN SAHARA
YEMEN
ZAMBIA
ZIMBABWE
U.S. Phone
*
(
)
-
International Phone
*
Email
*
All payments provided to
Central Association of the Miraculous Medal
comply with U.S.
laws and regulations.
miraculousmedal.org
© Copyright 2024
Central Association of the Miraculous Medal
All Rights Reserved