Create a memorial or tribute
in the Immaculate Conception Candle Shrine

You may complete this form online or download a printable form to mail.

Memorial/Tribute Information

*Please select a plaque size
4" x 16" plaque - 4 lines; 32 characters or spaces per line ($500)
8" x 8" plaque - 6 lines; 18 characters or spaces per line ($500)
8" x 16" plaque - 6 lines; 32 characters or spaces per line ($1,000)

*Line(s) to be etched:






(Note: Do not add spaces at the beginning. Text will be centered.)

Total: $