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Auxiliary Membership Application

Please fill out the required fields.

Required fields are marked with * below.

First Name*:
Last Name*:
Date of Birth*:
Address 1*:
Address 2:
City*:
State*:
Zip*:
Country*:
Home Phone Number*:
Work Phone Number*:
Email Address*:
Have you ever belonged to a hospital auxiliary?*:	Yes No
If so, where?*:
For how long?*:
List any community, civic, social, other affiliations and/or volunteer experiences.*:
Check type of membership/ Annual dues information:	Active Member (100 hours of volunteer service annually/ full benefits). Annual Dues of $10.00 Associate Member (Does not volunteer within the Hospital System. Member may choose to assist in organization leadership, fundraising events or attend Auxiliary functions). Annual Dues of $15
Check areas of interest for participation:	Christmas Projects: Sew Stockings for babies; Shopping for Christmas Family. Department Grants: Participate in application process and selection of grant recipients. Fundraising: Assist with planning and implementation of fundraising events. Publicity: Assist with coordination of design of posters, mailings, etc. Scholarship Committee: Participate in application process and selection of scholarship applicants. Telephon: Coordinate support scheduling for fund raising events and keep members updated. Board: Serve as Committee Chair, Officer or Other Board Member. I am unable to participate at this time but may be interested in the future.

Dues: Associate Member ($15 Annually)
Active Member ($10 Annually)

Make check payable to Woman's Hospital Auxiliary then mail to:
Woman's Hospital Auxiliary
c/o Volunteer Service Department
9050 Airline Hwy.
Baton Rouge, LA 70815
Phone: (225) 924-8156