Name *

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Miracle / Prayer Granted *

If applicable, please provide a date of when your prayer request or miracle occurred. An estimated date suffices if an exact date is not available.

MM

DD

YYYY

Verification *

It is necessary for the Cause for Canonization that all information submitted be true and accurate, to the best of your ability.

I hereby certify that, to the best of my knowledge, the provided information is true and accurate.

Publication Consent

I consent that the information provided may be published both digitally and in printed documentation and publications to help further the Cause for Canonization of Fr. Verbis Lafleur.

Anonymity

I wish for my identity and all names provided within my submission to remain known only to Ecclesiastical authorities and those charged with the Cause for Canonization.