Full name:

Address:

City:

State:

Zip code:

E-mail address:

Phone number:

Do you have a close relative who is/was a Auxiliary member?

Relative's relationship to you:
Mother Grandmother
Great-grandmother Aunt
Sister Cousin Daughter

Relative's full name:

Are you interested in joining a Auxiliary closer to your home?
I live in the Maine area and would like to join the a Auxiliary near me
I don't live in Maine - tell me about a Auxiliary near me.

Anything else we should know? Please tell us here: