YOUNG ADULT CATHOLIC CONNECTION
Membership Form 2008
Membership expires on January 31, 2009
Membership Fees: $16/year Singles and $25/year for married couples
Please print this page, fill in the details and mail it along with your check (made out to YACC) to YACC, 12700 W. Howard Avenue, New Berlin, WI 53151
First Name: _______________________________________________________________
Last Name: ________________________________________________________________
Address: __________________________________________________________________
City: State: Zip Code: ________________________________________________________
Home Phone: _______________________________________________________________
Email Address: ______________________________________________________________
Date of Birth (mm/dd/yy): ____________________
Male / Female
Parish: ____________________________________________________________________
How did you hear about YACC? _________________________________________________
I _______________________ (print name) acknowledge that YACC is a nonprofit group. I also understand that membership fees and U.S. Mail fees are collected only to cover costs and that YACC receives no funding from the Milwaukee Archdiocese, any Parish, or other source besides membership dues. Any funds left after expenses and when and if this group ceases to exist, will be turned over in full to St. John Vianney Parish in Brookfield, WI. In signing this form, I accept that I may hold no person affiliated with YACC, nor any organizer of any YACC event liable for any injury, property damage, or any other loss sustained at YACC events or YACC-related events. I understand it is my responsibility to notify YACC of any changes of information provided on this form. I also grant YACC the right to use any pictures in YACC promotional material (i.e. the website) and waive all rights to remuneration for such use.
Signature: ______________________________________________
Date: __________________________________________________