The Center for Positive Living cherishes its members. Please help us update our records by filling out this form, knowing as you do that you are helping our Center grow in many ways.

Member Status:	Renewal New
Name
Mailing address:
Email address:
Phones:	Home:	Work:
	Cell:	Fax: Home or work?
Tell us about yourself:
Birth Month & Day
Hobbies /Talents:
Church Activities of Interest:
----------------------------------------------------------------------------------------------------------------------------
I (we) pledge to support the Center’s annual operating costs in the following ways:
(1) With $	weekly monthly yearly
With check or cash Using a debit/credit card (we’ll call you)
(2) Some other way:
Submission of this form qualifies as your digital signature. Thank you for your renewal and your pledge.

© 2003- The Center For Positive Living
1795 Old Moultrie Rd St. Augustine, FL 32084
Phone & Fax: (904) 825-3600 Prayer Line: (904) 825-0815
Email - cploffice@bellsouth.net

ANNUAL MEMBER COMMITMENT CENTER FOR POSITIVE LIVING

ANNUAL MEMBER COMMITMENT
CENTER FOR POSITIVE LIVING