St. Lucy's Auxiliary Renewing Membership Form

Form Info	Please fill out the following form, items in bold are required!
First Name
Last Name
Members Title			If other:
Husbands Name
Husbands Title			If other:
Mailing Address
City		State	Zipcode
Phone Number	Home No Spaces and No Hyphens ex: 4125556666		Cell ex: 4125556666
Email

Have you been a member for the past five years and would like to be a Junior Medallion Sponsor?	Yes	No
Are you a mother of a junior medallion member?	Yes If Yes Daugthers Name:	No
Would you like to join a committee?	Yes	No

Please mail me a Vision of Hope Invitation this year

Yes

No

Please mail me a Medallion Ball invitation this year

Yes

No

Please mail me a Directory this year	Yes	No

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