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Membership Application

Please fill in this form for our directory and data base.

After sumitting your form, please remit a check for $75 to:
Christ Child Society of Northern Michigan, P.O. Box 132, Harbor Springs, MI 49749

Contact information

Email *

Verify Email *

Name *

First Name

Last Name

Mobile Phone

Spouse

First Name

Last Name

Birthday

Local / Summer Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Winter Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Local Phone

Winter Phone

Please indicate areas of potential interest:

Publicity

Newsletter

Photographer/Video

Submitting Press Releases

Writer

Basic Needs

Back Packs/Head Start Children

Infant Layette Assembly

Shower of Love (new back to school clothing)

Camps

Camp Quality, backpacks

Spirit Day (October)

Community Outreach

Christmas Shopping

Char-Em Christmas Parties

Diaper Pantry

Tutoring (elementary)

Wolverine Schools Outreach

Membership

Assist with Mailings

Serve as a committee chair

Serve on the Board

Event Planning

Annual Fundraiser (July)

Luncheon Committee

Needlework

Crocheting

Knitting

Sewing

Other Areas of Interest:

Please tell us a little about yourself

Any additional Information:

Who may we thank for referring you to CCSNM?