The Shawnee Indian Mission Patriots Membership Application

Name _____________________________________________________

Address ___________________________________________________

City, State, Zip _____________________________________________

E-mail address (optional) _____________________________________

ANNUAL MEMBERHSIP:

Individual ______$15.00       Family_____$25      

Please make check payable to The Shawnee Indian Mission Patriots

Please return to:

The Shawnee Indian Mission Patriots

c/o The Shawnee Indian Mission

3403 West 53rd Street

Shawnee Mission, KS  66205

I would like to receive information about volunteer opportunities at the Shawnee Indian Mission  _________Yes    _________No

Contributions are tax deductible to the maximum extent allowed by law.