St. Jude 500 Club Waitlist

Name (If splitting a number list all members names) *

Email (If splitting a number list one primary contact) *

Address (If splitting a number list one primary contact) *

Phone number (If splitting a number list one primary contact) *

St. Jude Affiliation (Select the one that best represents you.)

Parishoner

Friend/Family Member of Parishoner

Parent of Student at St. Jude School

Friend/Family Member Student at St. Jude School

CYO Member

Prep Member

Ministry Member

Faculty Member of St. Jude School

Staff Member of St. Jude School

Staff Member of St. Jude Parish

Alumni of St. Jude School

Other:

Captain *

Sister Elizabeth/ Tim Lynch

Jeanne Calhoun

Patty Cole

Katie Croce

Ted & Tracy Dufner

Amanda Flavell

Kristin Goettner

Melissa Ceresi-Leiser

Theresa Leone

Robin Mogg

Danielle Rauchut

Meg Zakarewicz

Need a Captain

Other:

Payment Option- Cash to Captain Preferred, Checks Payable to Cash *

1 Time Payment $500 (February)

2 Payments of $250 (February & March)

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