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R.E. Payment Form

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  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Street 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.
  
  Payment Selection REQUIRED 10 – First Communion 20 – First Communion 60 – First Communion 20 – Confirmation 40 – Confirmation 60 – Confirmation 100 – Confirmation Please fill out this field.
  
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