State Ladies Auxiliary Registration Form

STATE LADIES AUXILIARY REGISTRATION FORM PLEASE PRINT ALL INFORMATION

Date ______

AUXILIARY INFORMATION

AUXILIARY NAME: ______

IF NEWLY FORMED AUXILIARY PLEASE CHECK √ □

KC COUNCIL NAME: ______# ______

PARISH: ______

Address ______City:______Zip code______

Date Auxiliary formed? ___/____/____ # Charter members______Current # Members______

Auxiliary meeting Location ______Times______

PRESIDENT:______

Address:______PO BOX # ______

City ______Zip code ______- ______

Phone Home (_____)______Cell ( )______

E Mail Address______

LADIES AUXILIARY SECRETARY______

Address______PO BOX # ______

LET'S GROW AS A TEAM Revised SD July 17,2009 STATE LADIES AUXILIARY REGISTRATION FORM PLEASE PRINT ALL INFORMATION City ______Zip code______- ______

Phone Home (_____)______Cell (_____)______

E Mail Address______

Return copies to: Illinois State Council State Ladies Auxiliary Chairlady Office Manager Sandy Decker P.O. Box 681 3 So. 585 Haylett Ave. Kankakee, IL 60901 Warrenville, IL 60555-3224

LET'S GROW AS A TEAM Revised SD July 17,2009