Please print this form from your computer, complete it, and mail it with your check to:

Integrity/Minnesota
P.O. Box 19135
Minneapolis, MN 55419

REQUIRED INFORMATION:

Name(s):  

Mailing Address:  

City:  

State:

ZIP Code:  

OPTIONAL (but helpful) INFORMATION:

Home Phone:  

Work Phone:  

E-mail Address:  

WWW Home Page:  

Parish (if any):  

Membership Category:

• _____  Sponsoring Parish/Organization  ($99 per year)
  

• _____  Couple  ($55 per year)
  

• _____  Individual  ($33 per year)
  

• _____  Student/Senior/Low Income  ($11 per year)

Please enclose a check made payable to:  Integrity-Diocese of Minnesota

Annual dues for National Integrity are included in these Minnesota Chapter Dues.
Integrity membership is tax deductible to the extent allowable under current IRS Codes.

All membership information is held in strictest confidence by Integrity, Inc.

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