Membership Form

Please complete the form below, then click the Print button at the bottom of the page.

Name[s]

Address

Telephone Number[s]

E-mail Adress[es]

Diocese
Southeast Florida

Chapter [if there is one in your area]
Fort Lauderdale

Type of Membership [choose one]
Individual membership for 1 year $35
Household membership for 1 year $60
Low income/student/senior citizen membership for 1 year $10
Lifetime membership $1000

Extras [choose all that apply]
International postage [if you live outside the United States] $15
Additional gift for national Integrity's ministry [optional] $
Additional gift for local chapter's ministry [optional] $

TOTAL
 Enclose your check made payable to "Integrity" $

   

Please mail your completed form and check to:

 Integrity Membership
620 Park Avenue #311
Rochester, NY 14607-2943

 Contributions above dues are tax deductible.  Thanks for your support!
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