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Association of the Miraculous Medal

Annual Membership Enrollment --Mail-In Form

Fill out the form below for as many as 12 members you plan to enroll. By enrolling 12 members you will become a Promoter of our Lady's Association. Promoters receive a Promoter's card and medal, share in a special papal blessing, and many other spiritual benefits.

   
Please type the member information on the lines provided below.
Member 1:
Member 2:

Title: (Mr., Mrs., Miss.)
Name:
Address:
City:


Child Adult Deceased
Do not add member to mailing list.

(Mr., Mrs., Miss.)





Child Adult Deceased
Do not add member to mailing list.
Member 3:
Member 4:
(Mr., Mrs., Miss.)





Child Adult Deceased
Do not add member to mailing list.
(Mr., Mrs., Miss.)





Child Adult Deceased
Do not add member to mailing list.
Member 5:
Member 6:
(Mr., Mrs., Miss.)





Child Adult Deceased
Do not add member to mailing list.
(Mr., Mrs., Miss.)





Child Adult Deceased
Do not add member to mailing list.
Member 7:
Member 8:
(Mr., Mrs., Miss.)





Child Adult Deceased
Do not add member to mailing list.
(Mr., Mrs., Miss.)





Child Adult Deceased
Do not add member to mailing list.
Member 9:
Member 10:
(Mr., Mrs., Miss.)





Child Adult Deceased
Do not add member to mailing list.
(Mr., Mrs., Miss.)





Child Adult Deceased
Do not add member to mailing list.
Member 11:
Member 12:
(Mr., Mrs., Miss.)





Child Adult Deceased
Do not add member to mailing list.
(Mr., Mrs., Miss.)





Child Adult Deceased
Do not add member to mailing list.

 
Want to enroll more than 12 members?

Simply complete the process again, print out your next list and mail it with the other list.


Your Information:

Title: (Mr., Mrs., Miss.)
Name:
Address:
City:




Method of Payment

Credit Card Information: