CAC OF RALEIGH MEMBERSHIP APPLICATION
PLEASE PRINT NEATLY
NEW
RENEWAL
NAME: Last __________________________________________ First ______________________________________
HOME ADDRESS: Street __________________________________________________________________________
City ___________________________________ State _______ ZIP ____________SEX: M / F
HOME PHONE (_____) _____-_______ BIRTH DATE (month/day) _______/_______ E-MAIL ____________________________
EMPLOYER _____________________________________________________________________________________
OCCUPATION/TITLE _______________________________________ BUSINESS PHONE (_____) _____-_______
DEGREE ______________________________ MAJOR ________________________________________________
COLLEGE ________________________________________________________ YEAR GRADUATED __________
COLLEGE LOCATION: City ___________________________________________________ State _______________
1.) Are you Catholic? ________
2.) Are you free to marry in the Catholic Church? ________
3.) Are you or have you ever been married? ________
4.) If you answered yes to #3, have you obtained a divorce? ________
If divorced, have you obtained a Church annulment? ________
Are you widowed? ________
CURRENT PARISH _________________________________________
Location _____________________________________
If accepted, would you like to have your NAME, CITY, PHONE & E-MAIL listed in our club roster? (or any combination of the above, circle choices) Yes No (please initial________)
If new, where did you hear about the Club? __________________________________________________________
MEMBERSHIP
Check membership status for which you are qualified: (Must be free to marry in the Catholic Church and at least 21
years of age.)
FULL MEMBERSHIP (single, Catholic, 4 year college graduate)
ASSOCIATE MEMBERSHIP (single, not a 4 year college graduate)
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For one year of membership, please send this FULLY
COMPLETED application with a check for $30.00, payable to "CAC of Raleigh",
to: I CERTIFY THAT I AM 21 YEARS OF AGE OR OLDER AND THE INFORMATION GIVEN IS BOTH TRUE AND COMPLETE. I UNDERSTAND THAT FALSIFICATION OF ANY INFORMATION WILL RESULT IN THE VOIDING OF THIS APPLICATION AND THE FORFEITURE OF ANY FEES PAID. I ALSO RELEASE THE CATHOLIC ALUMNI CLUB, ITS MEMBERS, AND ITS OFFICERS FROM ANY SUITS OR CLAIMS THAT MAY RESULT FROM AN INJURY OR ACCIDENT WHILE ATTENDING A FUNCTION. I, the undersigned, being a member of said organization, being duly aware of the risks and hazards inherent in consuming alcoholic beverages and driving under the influence, hereby elect voluntarily to participate in the functions, and I accept all risk of doing so and acknowledge that any action taken on my part was not the result of encouragement or influence of any type by said organization, its servants, officers, members and/or member's guests. I indemnify and hold harmless said organization, its servants, officers, and agents from any and all negligence, gross negligence, willful and/or malicious conduct on my part caused by the consumption of alcoholic beverages at said organiation's functions. I hereby acknowledge that the affixing of my signature hereto bears evidence to the fact that this is done voluntarily with full knowledge and understanding of the contents herein and consequences attached hereto. I UNDERSTAND THAT ALL INFORMATION GIVEN ABOVE IS CONFIDENTIAL AND IS NOT AVAILABLE TO THE GENERAL MEMBERSHIP.AN INCOMPLETE APPLICATION CANNOT BE PROCESSED AND WILL BE RETURNED TO ME OR DISCARDED. SIGNATURE ________________________________________________________ DATE ______ / ______ / ______ FOR OFFICIAL USE ONLY
EXP: _____/_____PROC: _____/_____/_____INQ: _____/_____ |