GWV Auxiliary Application Form

Personal information will be kept secure and not divulged to outside parties.

First Name:*

MI:

Last Name:*

Address Line 1:*

Address Line 2:

City:*

State:

Zip:*

Phone including area code:

Mobile phone including area code:

Email:

I am interested in fundraising events:

Yes

I am interested in volunteering in the gift and resale shops

Yes

I want to help with the gala committee

Yes

Dues Payment information:
Annual membership dues are $25. Master’s Membership dues are $10. Checks are payable to ‘Geisinger Foundation’. Credit card payments are accepted. The GWV Auxiliary
25 Church Street
Wilkes Barre, PA 18765-7501

Send membership payment notice

Yes

Contact me for credit card payment

Yes

Geisinger Wyoming Valley