Last Name   First Name Spouse's First Name

Address City State Zip County

Phone Number Cell Phone Email

Child 1 Age Male Female

Child 2 Age Male Female

Child 3 Age Male Female

Child 4 Age Male Female

Child 5 Age Male Female

Child 6 Age Male Female

Child 7 Age Male Female

Child 8 Age Male Female

My interests and areas where I am willing to lead and help:

Membership Dues:
First time member $10.00 / Renewing by June 30th $10.00 / By September 30th  $15.00 / After November 30th $20.00
 Submit Application and mail check to MCHE c/o Michelle Loewy, PO Box 142, Franklin, NC 28744
I (the under signed) have read the MCHE Statement of Faith and agree to honor the principles set forth as a member of MCHE.

I, the under signed, my spouse or family members will not hold any MCHE leader or member responsible for any accidents or injures, I or my child may receive while involved in any activities that we choose to participate in as a group member or guest.

Signature