PHILADELPHIA SENATUS – LEGION OF MARY
|
Title: (Mr.) (Mrs.) (Miss) |
Last Name: _____________________ |
First: ______________________ |
|||||||||
|
Office: ____________________________________________ |
Term: first ( ) second ( ) |
||||||||||
|
Council: _______________________________________________________________________________ |
|||||||||||
|
Praesidium: ____________________________________________________________________________ |
|||||||||||
|
Attached to: |
(Parish): _______________________________________________________________ |
||||||||||
|
|
(School): ______________________________________________________________ |
||||||||||
|
|
(Other): _______________________________________________________________ |
||||||||||
|
City: ____________________________________________ |
State: _____________________________ |
||||||||||
|
Promise Made: Yes ( ) No ( ) |
Due Date: _____________________________________________ |
||||||||||
|
Date Appointed/Elected: __________ |
Date Instructed: __________ |
Date Ratified: _______________ |
|||||||||
|
Home Address: _________________________________________________________________________ |
|||||||||||
|
City: _________________________________ |
State: ____________________ |
Zip: _____________ |
|||||||||
|
Home Phone: _____________________________ |
Work Phone: _______________________________ |
||||||||||
|
Cell Phone: _______________________ |
Email address: ___________________________________ |
||||||||||
PHILADELPHIA SENATUS – LEGION OF MARY
|
Title: (Mr.) (Mrs.) (Miss) |
Last Name: _____________________ |
First: ______________________ |
|||||||||
|
Office: ____________________________________________ |
Term: first ( ) second ( ) |
||||||||||
|
Council: _______________________________________________________________________________ |
|||||||||||
|
Praesidium: ____________________________________________________________________________ |
|||||||||||
|
Attached to: |
(Parish): _______________________________________________________________ |
||||||||||
|
|
(School): ______________________________________________________________ |
||||||||||
|
|
(Other): _______________________________________________________________ |
||||||||||
|
City: ____________________________________________ |
State: _____________________________ |
||||||||||
|
Promise Made: Yes ( ) No ( ) |
Due Date: _____________________________________________ |
||||||||||
|
Date Appointed/Elected: __________ |
Date Instructed: __________ |
Date Ratified: _______________ |
|||||||||
|
Home Address: _________________________________________________________________________ |
|||||||||||
|
City: _________________________________ |
State: ____________________ |
Zip: _____________ |
|||||||||
|
Home Phone: _____________________________ |
Work Phone: _______________________________ |
||||||||||
|
Cell Phone: _______________________ |
Email address: ___________________________________ |
||||||||||