Children's Bureau Auxiliary
Membership Application

Name:

Address:

Phone: Email:

Cell Phone:

If married, husband's name:

Birth Month?    Birth Day?    Maiden Name?   

Are you employed?    Full Time?    Part Time?

Company:

Type of Work:    WorkPhone:

 
What are your special interests, hobbies and leisure activities?


Name/Source of Referral (if applicable)?


New member responsibilities include completion of 2 orientation sessions, five hours of direct service, annual dues of $50, and attendance at as many monthly meetings as possible. Active membership (second, third, fourth and fifth year in the Auxiliary) responsibilities include a minimum of 50 hours of service per year, annual dues of $50, and attendance at as many monthly meetings as possible. Associate membership (sixth through tenth year in the Auxiliary) responsibilities include a minimum of 15 hours of service per year, annual dues of $50, and attendance at as many monthly meetings as possible.

Thank you for your interest. Please return this application to the Membership Chair by clicking on SUBMIT. If you have any questions, please contact Andra Sudler at (317) 638-4562 or asudler@sbcglobal.net.