Membership Form – Ladies of Charity of the Diocese of Buffalo

Application Date

Name

First Middle Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Winter Address (if different)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Present/Former Occupation

Home Phone

Work Phone

Cell Phone

Parish

How did you learn about membership in the Ladies of Charity?

Referred by

Please select one

If other, please explain

Dues must accompany this application. LOC dues year is August 1st to July 31st. You may choose your level each year, minimum dues are $25.00. A portion of your dues is sent to LCUSA (Ladies of Charity of the United States of America®) Please make check payable to Ladies of Charity, Diocese of Buffalo

Donation Amount

Members of Ladies of Charity may choose the amount of their annual dues: Silver $25-$49, Gold $50-$99, Platinum $100 and up.

Total