PLEASE FILL OUT THE FORM AND RETURN WITH ...

PLEASE FILL OUT THE FORM AND RETURN WITH YOUR CHECK FOR $10 PAYABLE TO ST. JOHN’S: St. John’s Episcopal Church Communion Wine Dedication 202 Gordon Drive SE Decatur, Alabama 35601 Please print clearly. Information will be printed in bulletin as written. Fill out a separate form for each Sunday request.

DEDICATION DATE: _________________________________ IN MEMORY OF:

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ AND/OR

IN THANKSGIVING FOR (BE SPECIFIC):

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________ AND/OR

IN CELEBRATION OF (BE SPECIFIC):

__________________________________________________________________ __________________________________________________________________ __________________________________________________________________

GIVEN BY:

___________________________________________________________________ ___________________________________________________________________