Children's Bureau, Inc. - Auxiliary Membership Application


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Contact:
asfrick@comcast.net
317-634-5050

Children's Bureau Auxiliary

ONLINE AUXILIARY MEMBERSHIP APPLICATION

Contact Information:

Full Name:

Address:

City:

State:

Zip:

Email:

Phone:

Cell:

About You:

If married, husband's name:

Maiden Name:

Birth Month:

Birth Day:

What are your special interests, hobbies, and leisure activities?

Employment: (if applicable)

Are you currently employed?		Employment status:
	Yes		Full time
	No		Part time

Company:

Type of Work:

Work Phone:

Referral Information: (if applicable)

Please tell us the name and/or source of your referral to the Auxiliary:

New member responsibilities include completion of orientation, five hours of direct service, annual dues of $50.00, and attendance in 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 $50.00, 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 $50.00, 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.

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