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The persons listed have a Holy Union registered with DignityUSA National Registry. The persons hereby agree that the Holy Union is dissolved and wish to have their Union removed from the Registry of DignityUSA immediately. |
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The persons listed have a Holy Union registered with DignityUSA National Registry. The persons hereby agree that the Holy Union is dissolved and wish to have their Union removed from the Registry of DignityUSA immediately. |
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Please Print |
First Person |
Second Person |
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Full Name: |
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Address: |
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City: |
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State & Zip: |
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Signature(s): |
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Date of Holy Union: |
Chapter: |
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Chapter President/Representative:
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The individuals listed above were united in Holy Union Service.
Please print & mail this form to:
DignityUSA,
1500 Massachusetts Ave NW, Suite 11, Washington DC 20005,
or FAX to:
202-429-9808
