WAITLIST | Civinettes

First Name

Last Name

Address

City, State, MS

School

Grade

I hereby request membership in the Madison Junior Civitan Club. I agree to abide by the international, district and club constitutions, bylaws and po

Why do you want to be involved in Civinettes?

Reflect on how your life experiences have lead you to be civic-minded:

Explain in detail your top 3 goals and the steps you will take to achieve them?

Name the most meaningful projects in which you have served and how they shaped your life.

Who is your hero and why?

I have read the Obligations and Commitment to Madison Junior Civitan Club and agree to my obligations as a potential member.

Potenital Member Signature

Parent First Name

Parent Email

Parent Last Name

Parent Phone

I agree to the financial obligations of $165 per Civinette Member

Thanks for submitting!

Civinettes Calendar