Villa Maria Circle
Enrollment Form
If you would like to
send a Villa Maria Circle Card, please print this form and return it to Villa
Maria Circle,
Sr
Jean Babeaux, HM,
A card will be sent to you to give
either the person enrolled or a relative/friend of the person enrolled.
Name of Person Enrolled:
__________________________________________________
Living: _______________ Deceased: _______________ Date: _______________
Number of Years Enrolled:
______________________ Perpetual:
_________________
Card:
__________________________________________________________________
Presented by (Name):
_____________________________________________________
Address: ________________________________________________________________
City: ___________________________
State: ______________ Zip:
________________
Phone Number:
__________________________________________________________
Email Address:
___________________________________________________________
Donation Enclosed:
_______________________________________________________
If you would like the Villa Maria
Circle perpetual enrollment mailed directly to a person other than yourself,
please complete the information below and include an additional $1.00 for
postage. Thank you.
Name of Person:
_________________________________________________
Address of Person:
_______________________________________________
City:
____________________________ State:
_______________ Zip: ________
May
God Bless 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 $10.00
Villa
Maria Circle, P0 Box 207, Villa Maria, PA 16155
A
Ministry of the Sisters of the Humility of Mary