Become An Auxiliary Member

St. Dominic Hospital Auxiliary Membership

Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone (home)
Phone (cell)
Email
New Membership or Renewal?*
- Renew My Membership
- New Membership
New Membership Category*
Please select a Membership category below.

Active Members are expected to participate in Auxiliary activities.

Associate Members pay dues and are kept informed, but they are not required to participate actively. Associate dues help defray costs for the general costs of operations such as directories, newsletters, etc.

Please Check Membership Category to Renew
- Active Membership, $20
- Associate Membership, $30
Membership Renewal Category*
Please select a Membership category below.

Active Members are expected to participate in Auxiliary activities.

Associate Members pay dues and are kept informed, but they are not required to participate actively. Associate dues help defray costs for the general costs of operations such as directories, newsletters, etc.

Please Check Membership Category to Renew
- Active Membership, $20
- Associate Membership, $30
- Please remove my name from the membership list and mailing list
Total
$0.00
Payment
Enter your credit card information to complete your membership transaction.
Secure Credit Card

Card Holder*

Card Number*

Card Expiration*

Card CVV*
CAPTCHA