Clothe-A-Child Membership Application

We want to become member(s) to help Clothe-A-Child provide clothing to needy children in our community:

		Annual Membership Fees
	Organizational Membership	$ 125.00 (Minimum)
	Individual Membership	$ 25.00
	Youth Membership (to age 18)	$ 10.00

Name:
Address:
Telephone:
Email Address:

Method of Payment:
		Bill Me
		Check or Money Order
		Send check or money order to: Clothe-A-Child, Inc. 2124 West Muhammad Ali Blvd. Louisville, KY 40212

To submit this form, please enter the characters you see in the image: (If you cannot read the image, click Refresh on your browser.)