Membership Application

Decrease Font Size Increase Font Size

 

Name ________________________________________ 

Address ______________________________________ 

City, State Zip _______________________________ 

Home Phone __________________________________ 

Work Phone __________________________________ 

Email Address _________________________________ 

Parish/Church/Synagogue _______________________ 

 New Member 
 Renewing Member 

Annual Membership Categories
 
$ 10 Regular 
$ 25 Contributing 
$ 50 Sustaining  
$100 Patron  
 
$200 Life Member* 
*If you are a lifetime member and would like to make an additional contribution, please indicate the amount of your donation $_______________.

 
I would like to be contacted to learn more about volunteer opportunities. 

Please make your check payable to :
Women's Auxiliary of SFHMC
114 Woodland Street
Hartford, Connecticut 06105

 
For Health Professionals | Board of Directors | Employees | Site Map