PPMA MEMBERSHIP FORM
(Oct. 1, 2009 - Sept. 30, 2010)
PPMA membership is open to all Professional Pastoral Ministers serving in the Diocese of Lansing. This includes both paid positions and volunteers.  Please fill out



Name __________________________________________

        New ______  Renewal __________ Date __________

Preferred Contact:  W ___________   H _______________

Home:
Address ________________________________________

City __________________________ Zip ______________

Phone:  W _____________   H ______________

E-mail:  W __________________  H ___________________
               please include your e-mail address if you have one
Fax _____________________

Work:
Address ________________________________________

_______________________________________________

City __________________________ Zip ______________

Phone:  W _____________   H ______________

E-mail:  W __________________  H ___________________
               please include your e-mail address if you have one

Fax _____________________

Current Ministry _________________________________

Parish _________________________________________
        Please designate if this is your home parish or work parish

Type of Ministry:  Circle all that apply

Commissioned Ecclesial Lay Minister   (        )
                                                                    YEAR                                                                                                                                    Professional       Workplace          Unpaid         

                  Ordained       Religious

Membership fee:  $30.00     Make check payable to:  PPMA
           October 1, 2009 thru September 30, 2007

Membership includes: free attendance to fall and spring events, newsletter, regional representation

Send completed form and fee to:
    Sam Lalomia, Treasurer
     PPMA
     311 South Thompson
     Jackson  MI  49203

**to print this form, cut and paste to Word document, print on your computer and mail**