Membership Application

Name ________________________________________

Address ______________________________________

City, State, Zip _______________________________

Home Phone __________________________________

Cell or Work Phone _____________________________

Email ________________________________________

MembershipType 

$15 Supporting

$25 Contributing

$100 Patron

$200 Life Member* 

*If you are a lifetime member and would like to make an additional contribution, please indicate the amount of your donation $_______________.

If Employee please indicate:

Saint Francis Campus _________

Mount Sinai Campus __________

I would like to be contacted to learn more about volunteer opportunities.

Please make your check payable to :
The Auxiliary at Saint Francis
114 Woodland Street
Hartford, Connecticut 06105

Thank You for Generous Support of our Mission