Miscarriage Memorial by LK2MHZ

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									      Miscarriage, Infant or Child Loss
                Memorial
Please return this form and join us even if your child was remembered a previous year. Each year's service
and momento given will be different! Please duplicate this form for others! For further information, contact
                                                Pam Mullins.
           Parish: 739-0331 ext. 319 Fax: 749-9771       Email: pmullins@stbernardappleton.org
   Please return this portion by Oct. 26, 2009, to have your child's name included in the Memorial
                                               Program.

       Return to: St. Bernard Church, 1617 W. Pine Street, Appleton, WI 54914
                                                                                                                         Kno
_____I will attend the service on November 1, 2009. I will be bringing ______guests.
_____I cannot attend the service, but would like a copy of the program.
            (You may pick up a copy at the Parish Office anytime after 11/1/09)

_____I would like my child(ren)'s name(s) to be included in the service and program.
PLEASE PRINT!
Child(ren)'s Name(s)_________________________________________________________________
          (If you have not named your child, we invite you to do so. Some people call the child “Baby” with last name,
such as "Baby Smith".)

Your Name____________________________________________________________________
Relationship to child:____________________________________________________________
Address ______________________________________________ Phone _________________
                   Street                                  state               zip

                 Donations for the memorial are appreciated, but not necessary.

              Sixteenth Annual "Tree of Light - Wreath of
                        Remembrance" Service
                                      November 1, 2009
                                  All Saints' Day - 7:00 p.m.
                                           St. Bernard Church
                                           1617 W. Pine Street
                                        Appleton, Wisconsin 54914

                                    Sponsored by
     St. Bernard’s, St. Therese’s and St. Mary’s Greenville Elizabeth Ministries.

                              Open to people of all faiths!
               Perhaps they are not the stars, but rather openings in heaven
                where the love of our lost ones pours through and shines
                      down upon us to let us know they are happy.

								
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