Auxiliary

Membership Application Form

A welcome to you from the Mercy Auxiliary. If you are a new member, thank you for joining our organization and supporting our efforts. As an auxilian you will receive the Auxiliary newsletter, publications and invitations to special events. We thank you in advance if you have decided to participate in one or more of our activities:

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Whether you choose to be an active member or support us by contributions, we want you to know that we appreciate your membership.

Address _____________________

City _________________________

State _____   Zip _________

Telephone (_______) ___________________

Email Address __________________________

Membership (Check one):

__Renewal

__$10 Regular Mbrship

__New

__$100 Lifetime Mbrship

__Contributon $______________

__ Auxiliary Project - Area of Interest __________________________

__ Hospital Volunteer - Area of Interest __________________________

Please print out this form and mail it to:

Mercy Auxiliary Membership
701 10th St SE 
Cedar Rapids, IA 52403

Please make check payable to Mercy Auxiliary. Please do not send cash.