formmembership

To become a member of LND/SMC:
1.        Please complete the following information.
2.        Send this form along with a check for $20 for your dues to:
            Pam Chipman, 1208 Leeper Ave., South Bend, IN 46617.
3.        Deadline for inclusion in the member directory is October 14, 2009.
4.        You must be a member of LND/SMC to participate in Interest Groups.

Last Name __________________________________ First Name ____________________________
Street Address _____________________________________________________________________
City, State, Zip Code        _____________________________________________________________

Home Telephone Number    ___________________________________________________________

E-mail Address _____________________________________________________________________

Are you an employee of Notre Dame or Saint Mary’s?
Circle ND or SMC   and indicate department: ____________________________________________
Title of your position (as listed in the campus directory) ______________________________________
Your Campus Address _______________________________________________________________
Do you want the newsletter sent to your home or campus address? _________________

Is your spouse an employee of Notre Dame or Saint Mary’s?
Circle ND or SMC   and indicate department: ____________________________________________
Spouse’s Name        _________________________________________________________________
Title of your spouse’s position (as listed in the campus directory) ______________________________
Spouse’s Campus Address        ________________________________________________________

Are you new to the Notre Dame/Saint Mary’s community within the past year? _____________

$_______        To become a member, please pay annual dues of $20.
                         Make your check payable to LND/SMC.

$_______        To make a Life Member Sustaining Donation
                         Make your check payable to LND/SMC

$_______        To make a donation to our Notre Dame Scholarship Fund,
                         Make your check payable to University of Notre Dame.*

$_______        To make a donation to our Saint Mary’s College Scholarship Fund,
                         Make your check payable to Saint Mary’s College.*

    *Please include separate check for each scholarship donation. Thank you.

I am interested in participating in or helping with the following interest groups:

___ Craft Night                                   ___ Morning Literature (Book Club)

___ Creative Cooking                         ___ Newcomers

___ Evening Literature (Book Club)    ___ Playgroup                                     ___Tennis

  Elect to receive your LND/SMC Kaleidoscope by:                                                     ___ Electronic Mail
(Please check one. If nothing is checked it will come by 1st Class)                           ___ Campus Mail
                                                                                                                                    ___ Regular 1st Class Mail

Ladies of Notre Dame and Saint Mary’s College
2009-2010 Membership Form