APPLICATION TO RECEIVE MARINER

Please submit the following widow’s name to begin receiving the Mariner 4 times a year.

AUXILIARY NAMES AND NUMBER__________________________________________________

MEMBERS NAME________________________________________________________________

STREET ADDRESS________________________________________________________________

CITY_________________________________________STATE_____________________________

9 DIGIT ZIP CODE____________-___________.

This subscription is good from September 2006 thru August 2008 We will require that ALL subscriptions be renewed every two years in September.

If there is a change of address during this two year period, please notify the State Chair-couple Doug and Patty Kissinger, 149 Iowa Drive, Ozark, MO 65721, as we will be the only ones maintaining the mailing list. DO NOT notify your Grand Knight or District Deputy.

(Ladies Auxiliary President, please duplicate this form for as many members as you need)