Membership Form

1.    Check membership category:

q  $30 Individual          q  $1,000 Life membership

q  $20 Senior

2.    Select payment method:

q  Check or money order enclosed.

               (Make check or money order payable to CATHOLIC LEAGUE)

q Charge to my  q VISA  q MasterCard  q Discover  qAmerican Express

Card number: ______________________________________________

Expiration date: ____/____

Signature (required if using credit card) ________________________

Please Print    q  Mr.     q  Mrs.      q  Miss      q  Ms.        q  Other

NAME: _____________________________________________

ADDRESS: ___________________________________________

CITY/STATE/ZIP: _____________________________________

PHONE  (AREA CODE ________)  ______________________