|
|
|
|
|
|
The Mended Hearts, Inc.
Greater Evansville Chapter #107
Evansville, Indiana
To be a member of any Mended Hearts chapter, you must join the National Organization. Your membership will include two insignia pins for a Family Membership or one pin for an Individual Membership. New members also receive a quarterly copy of Heartbeat. This is a magazine produced by Mended Hearts, Inc. You will also receive copies of our Chapter's newsletter, The Tri-State Thumper.
Dues and Donations are Tax Deductible. IRS 501 (C)(3)
Interested persons wishing to join, please make checks payable to: The Mended Hearts, Inc. Send this application and check to: Sue Karges, Treasurer, 6305 E. Baseline Road, Evansville, IN 47725.
Family Membership (2 or more in a household)
New Member $34.00
Renewal $27.00
Life Member $220.00
Individual Membership
Renewal $17.00
Life Member $155.00
Date: _________
Name __________________________ Phone ___________
Street _____________________ City __________________
State ______________________ Zip __________________
Surgery Date or Treatment ________ Hospital ___________
Type of Surgery or Treatment _________________________
Email _______________________ DOB ______________
Spouse _______________________ DOB ______________
Please Answer All Questions
|
|
|
|
|
|
