Date: ____________________

REGISTRATION APPLICATION

Check one:   New Member    Renewal

Note: This information will be used for our Member-Directory.  Please fill out completely even if renewing.

Family Last Name ______________________   Phone (         ) ______________________

Fathers Name _________________________    Mothers Name ____________________

Address __________________________________________________________________

City __________________________________   State _____________ Zip ____________

E-mail (home)__________________________ ( Office e-mail)______________________

Childrens Names and Grades.  Birthdate please, Month and Year

1. __________________________________   6. _________________________________

2. __________________________________   7. _________________________________

3. __________________________________   8. _________________________________

4. __________________________________   9. _________________________________

5. __________________________________   10. ________________________________

Will you have a graduating senior?  Y  N   If yes, childs name __________

Will you have a graduating 8^th grader?  Y  N   If yes, childs name ________

Which parish in the Arch-Diocese do you attend? _______________________________  

Curriculum Used __________________________________________________

(Seton, OLVS, Kolbe, OLRS, Eclectic, Traditional, Classical, etc)

Committee Participation:(Please indicate in which committees you would like to volunteer assistance)

 Directory  Curriculum Fair  Budget  Graduation Mass & End of Year Event

 Back-to-School Social & Mass   Activities & Socials  Telephone

Would you be interested in being a Satellite Leader for your area?  Y  N

Would you be interested in composing the ARCH Angel Newsletter?  Y  N

Would you be interested in being a member of the Board ?  Y  N

Membership Fee:  For first time members, please see chart:

Family/Individual/Associate Membership -. $20 (prorated)

Aug-Nov. $20	Dec-March $15	April-Jul  $10.

Renewal Membership Fee:  $20 annually

FOR OFFICE USE ONLY:                                                                                                                                                (Revised 04.30.07)