BECOMING A MEMBER

Family's Marital Status

Single

Married

Divorced

Widowed

Separated

Husband's Name

First Name

Last Name

Husband's Cell

(###)

###

####

Husband's Date of Birth

MM

DD

YYYY

Wife's Name

First Name

Last Name

Wife's Cell

(###)

###

####

Wife's Date of Birth

MM

DD

YYYY

Home Phone

(###)

###

####

Wedding Date

MM

DD

YYYY

Please check any information you do not want published in the membership directory which will only be given to members of SNCCC.

Names

Address

Phone Numbers

E-mail Address

Do you have children?

Yes

No