Mass Intention Request Form

To have a Mass offered for an individual, special intention or need, please complete the form below.

1. Requestor Information

At Which Church Are You Requesting the Mass Intention?

St. Francis Xavier

St. John the Evangelist

St. Joseph

St. Kateri Tekawitha

Your First Name

Your Last Name

Your Email Address (Optional)

Your Phone Number. (The best number for the office to reach you if needed.)

Your Mailing Address so we can send you a Mass Intention Confirmation Card

Address Line 1

Address Line 2

City

State

Zip Code

2. Intention Details

Name of the Person for Whom the Mass Is Being Offered.

Please write the full name as you would like it to appear.

First

Middle (Optional)

Last

The Intention is for:

Living Person

Deceased person (Repose of the Soul)

Relationship to You (optional):

Reason for the Intention (optional):

Additional Notes (optional):

3. Mass Date Preferences

Please list your preferred date for the Mass intention.

Requested Date

Alternate Date:

Flexibility:

I am flexible with th date and time.

PLease contact me if my prefered date is unavailable

St. Francis Xavier Catholic Church of Sallisaw