Junior Civitan Membership Application

JUNIOR CIVITAN CLUB
MEMBERSHIP APPLICATION

NAME __________________________________________________              GRADE ________

ADDRESS _____________________________________________________________________

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TELEPHONE NUMBERS     HOME ___________________________   

                                                    CELL     ___________________________   

T-SHIRT SIZE _____________

WHY WOULD YOU LIKE TO JOIN JUNIOR CIVITAN?

FIRST SEMESTER SCHEDULE:

SECOND SEMESTER SCHEDULE:

THE MEMBERSHIP FEE OF $20.00 MUST BE TURNED IN WITH APPLICATION.  THE CREED MUST BE RECITED TO MRS. WRIGHT AT THAT TIME.  DEADLINE IS TUESDAY, SEPTEMBER 30.  THIS MUST BE TAKEN CARE OF DURING BREAK OR AFTER SCHOOL.  *MEMBERS FROM LAST YEAR DO NOT HAVE TO RECITE THE CREED AGAIN BUT MUST FILL OUT APPLICATION AND PAY FEE.

MEMBER AGREEMENT

I understand the requirements to remain a junior civitan member in good standing.  I know that I must abide by these requirements in order to remain a member of Junior Civitans and be eligible to order a graduation cord or to use on college applications.

                                                                              

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Member Signature                                                        Date