Print out this page. After you fill in the information, you can send it to the address below or bring it to Herrin Hospital.

_____________________________________________
Name
_____________________________________________
Address
____________________________________________
City, Sate


____Please contact me with more information about the auxiliary.
____Yes, I would like to be a member. Enclosed is my $5.00 annual dues. ($2.50 after October 1)

I wish to volunteer in the following areas:

______Gift Garden

______Greeter's Desk

______Hospital Services

______Surgery Hospital Desk

______I cannot serve as a volunteer at this time,

but wish to support the auxiliary as a member.

If you cannot make a weekly commitment, we need a list of persons who are willing to substitute occasionally (after initial training) in each area.

Please send your application to:

Herrin Hospital Auxiliary

c/o Membership Chairman

201 South 14th Street

Herrin, IL 62948