HOPE Network - Membership

Office Use Only
Date Rec.
Date Paid
Receipt # Cash M.Order Welcome	Check#

PLEASE DO NOT FAX APPLICATION BACK TO US.
MUST BE MAILED OR HAND DELIVERED WITH DUES.
THANK YOU

2008 HOPE Network Membership Application
Enclose dues of $5 (cash, check or money order) and mail to HOPE

PLEASE PRINT

Please notify us if your address changes.
Address changes through the Post Office cost your Network hundreds of dollars!

Name ______________________________________________________________

Address ___________________________________________________________

City ____________________,WI Zip _________

Home Phone		( ___ ) ___________

Work Phone		( ___ ) ___________

Cell Phone		( ___ ) ___________

Your Year of Birth _________ If Pregnant, Due Date ____________

Your race (optional; demographic statistics required by some funders): ________________________

Your Dependent Child(ren) - under age 18, living with you:

NAME (First and Last)	(B)OY OR (G)IRL	BIRTH DATE

** Our mission is to help single mothers and their children.

** Membership applications accepted only from January 1st - September 30th.

** Want to volunteer?
__ babysitting at Forum;
__ helping at family events;
__ giving a mom a ride to an event;
__ helping at the HOPE office in Menomonee Falls (requires a car).

Person or agency that referred you: ________________________________________________