CCW Membership Form

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Spouse's Name (If applicable) Please enter valid data.

Street Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Preferred Method of Contact REQUIRED Call Text Email Facebook Please fill out this field.

Birthday Month/Day REQUIRED Please fill out this field. Please enter valid data.

Year Joined CCW REQUIRED Please fill out this field. Please enter valid data.

Which Mass do you usually attend? REQUIRED 5:30 Vigil 8:00 AM 10:00 AM 12:00 PM 5:00 PM Please fill out this field.

Ministries to which you belong REQUIRED Lector Choir EMHC Other None Please fill out this field.

If Other, please list Please enter valid data.

Circles you would be interested in joining or are already a member of St. Elizabeth's (Cooking) St. Margaret's (Crafts) St. Therese of Lisieux (Gift Shop)

How would you like to get involved in CCW activities? Leadership Spirituality Fund Raising Advertising Food Service Assist with Events/Activities Undecided

I understand that the dues are $15 for the year. (Payment may be made at the first meeting OR checks may be mailed to St. Joseph CCW, Attn: Janet Kleeman, 4070 Conga St, Jacksonville, FL 32217)

I Agree Please select this field.

Confirmation Email REQUIRED Please fill out this field. Please enter an email address.