Please fill in the below information to receive the Blessed Sacrament

Surname
Christian Name
Email address
Address including post code	Street and Number Town State and Postcode
MOBILE Phone number,
Receiving Sacrament	Would you like to receive the sacrament (Breads) Yes No
If you would like to receive the sacrament for you and your family	Number of hosts (breads) required Please note that the Sacrament will be sent to you in the month preceding the service.
Help Finance Zoom Production	OPTIONAL - Is is suggested that participants contribute a regular donation towards Zoom costs. Do you support this Yes      No      Possibly
Birthdays Day and month only	Name and Date Name and Date Additional family members
Wedding Anniversary Day and month only	Date
200 Word Bio	Please provide a 200+ (or there abouts) word background to help the group get to know you quicker. Please also send a photo (Head & Shoulders OK) via our email address. (info@anglicanzoomchurch.com.au)
Any comments you may wish to make.
For donations, bank transfer details as follows ANZ Bank BSB: 015 259 Account: 3053 76236 Include your name in the 'Message' section.
'Zoom' Home Mass - 2nd, 4th & 5th Sundays- 4.30pm SA - 5pm elsewhere 5th Sundays incorporate an extended "Cuppa and Chat"