|If you do not have a program started in your area and would
like to choose an hour of prayer you may have it recorded at the
Shrine. Print out the form below and mail or e-mail to the Shrine.
Your name will be kept confidential.
Day of week___________________ Hour _____________ AM or PM
City _____________________State ________________ Zip __________________
Queen of the Holy Rosary
Mediatrix of Peace Shrine
W5703 Shrine Road
Necedah, WI 54646