VILLA MARIA CIRCLE
Enrollment Form for Perpetual
Membership
If you
would like to send a PERPETUAL Villa
Maria Circle Card, please print this form and return it to Villa Maria Circle,
Sr
Villa
A card will
be personalized and sent to you to give to the person enrolled or a relative/
friend of the person enrolled.
Name of Person Enrolled:
____________________________________________
Living:
_________ Deceased: ___________ Date:
_______
Large Certificate (10” x 7 ½”): _____________Small Card (6 ¼”x4 ¼”):________
Presented by ______________________________________________________
(Name as you
want it on the certificate or card)
Address: __________________________________________________________
City:
___________________State: ________Zip:___________________________
Phone
Number (where you can be reached during the day): __________________
Email
Address:______________________________________________________
Suggested
Donation $10.00 plus postage
Postage and
Handling: Large: $3.00
Small: $1.00
Total
Enclosed:
If you
would like the Villa Maria Circle Perpetual Enrollment mailed directly to
someone other than yourself, please complete the information below. Thank You.
Name of
Person: _____________________________________________________
Address: ____________________________________________________________
City:
_____________________State: ______Zip:_____________________________
If you
would like other cards to have at
home to send as needed please let me know by writing to
or by
email at vmcircle@humilityofmary.org Include your address and phone number on your
email. Thank you.
Suggested
Donations: One person for one year $2.00
One person for each additional year $1.00
One person for 5 Years $5.00
Perpetual Enrollment + postage $10.00
Thank you for your
support.
A Ministry of the