2012 Women's Cornerstone Signup

Women’s Cornerstone

Small Cross

Contact Information:

Vivian Suszczynski – pvjj83@verizon.net (973) 628-6953

Mary Ditore – maryditore@gmail.com (973) 696-6912

Our Lady of the Valley Church is located at 630 Valley Road, Wayne, NJ 07470. The parish office phone number is (973) 694-4585.

Registration Form:

First Name: *

Last Name: *

Address: *

City, State, Zip: *

Phone: *

Best Time to Call: *

E-mail Address: *

Name for Name Tag: *

Do you want to share your information with other attendees?: *

Emergency Contact-please provide two contacts, at least one not residing in your home:

Contact 1 Name: *

Contact 1 Relationship: *

Contact 1 Address: *

Contact 1 E-mail:

Contact 1 Phone: *

Contact 1 Cell Phone:

Second Contact-please provide information below:

Contact 2 Name: *

Contact 2 Relationship: *

Contact 2 Address: *

Contact 2 E-mail:

Contact 2 Phone: *

Contact 2 Cell Phone:

Please click submit below then print and mail the form that appears after submitting with a $75 donation before January 28, 2012 to cover meals and materials (Checks made payable to Our Lady of the Valley Church) to: Women’s Cornerstone, Our Lady of the Valley Church, 630 Valley Road, Wayne, NJ 07470.

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