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OUR LADY OF GRACE SOCIETY

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OUR LADY OF GRACE SOCIETY Powered By Docstoc
					OFFICERS:                                                       BOARD OF DIRECTORS;
ALFREDO A. ViVENZIO, J.D.
PRESIDENT/TREASURER                                             ANNE PANETTA

ANIELLO SCIBELLI                                                MARIA DEANGELIS
VICE PRESIDENT
                                                                Dr. PASQUALE DEANGELIS
LEA ADDEO
SECRETARY                                                       ALBERT BONAVITA

GIOIO SCIBELLI                                                  SALVATORE J. SCIBELLI, J.D.
SARGEANT AT ARMS




                               MEMBERSHIP APPLICATION
                                         FOR
                            OUR LADY OF GRACE SOCIETY, INC.


LAST NAME______________________FIRST______________________M.I._______________

ADDRESS:_______________________________________________________________________

CITY____________________________________________________________________________

TELEPHONE #____________________________________________________________________

EMAIL___________________________________________________________________________

ANNUAL MEMBERSHIP DUES:

$25.00 ANNUAL DUES PAID BY__________CHK____________CASH_______PD ON_________

ADDITIONAL DONATION AMOUNT $________________________________________________

RECEIVED BY________________________________

MEMBERSHIP #_______________________________

     THE UNDERSIGNED APPLICANT DOES HEREBY AGREE TO ABIDE BY THE
PURPOSE AND THE BY-LAWS OF OUR LADY OF GRACE SOCIETY, INC.


                                             _________________________________________
                                             SIGNATURE

MAKE CHECK PAYABLE TO:

                   OUR LADY OF GRACE SOCIETY, INC.

MAIL TO: ALFREDO A. ViVENZIO, ESQUIRE
        1120 MAIN STREET
        SPRINGFIELD, MA 01103



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