Our Lady of the Highways - Membership Application
Please Enter the following contact Information:
Name
Street Address
City
State/Province
Zip/Postal Code
Country
Home Phone
E-mail

Choose the type of Membership you want (Amount shown is the suggested donation).  Family membership includes young, non-driving children. Extended family members (e.g. aunts, cousins) are usually included in a group membership. When selecting a group membership, we only need the name of the group, not the names of each member of the group.

Individual ($5.00)    Family ($10.00)    Group ($25)

If you selected "family membership", please enter the names of your family members.  Separate each name by a comma.

If you selected "group membership", please enter the names of the people in the group.

Which of the following special intentions do you have?

Business Trip on
   Vacation on

Holiday Weekend on
   Commuting to

Other

 
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