Membership Form

Name *

E-Mail *

Address *

City *

State *

ZIP *

Home Phone

Cell Phone

Occupation

Employer

Emergency Contact Name

Emergency Contact Number

Birthday (MM/DD)

Would you like to be notified of events and updates via E-Mail? * Yes No

Can we print your information in the member directory? * Yes No

As an organization of St. Rita Catholic community, we request the following information:

Are you a Catholic single? * Yes No

Are you currently a Parishioner of a Catholic church? * Yes, St Rita Yes, Other Church No

If `St Rita`, please indicate your member number found on your weekly Mass envelope

If `Other Church`, please let us know which

Questions or Comments