Join the Pediatric Chaplains Network form

Join the PCN

To be a member of the PCN for the year 2010, complete this form and send a check for $50.00 made payable to Pediatric Chaplains Network (or PCN). Please mail to the PCN Business Manager at:

Chaplain Del Farris

Arkansas Children's Hospital

1 Children's Way

Little Rock, AR 72202

PEDIATRIC CHAPLAINS NETWORK

MEMBERSHIP FORM

Please type or print, very legibly. If we can't read your writing, your mail and e-mail come back as undeliverable. Help us stay in contact with you.

Name and Preferred Mailing Address:

_____________________________________________________________________________________________________

Place of Employment: _________________________________________

Daytime Telephone: ___________________________________________

E-Mail: ______________________________________________________

Membership in the PCN is open to pediatric chaplains and others interested in promoting the spiritual care of children and families in healthcare. Membership fees are $50 per calendar year. Please make your check or money order payable to the PCN.

All members whose dues are received by April 1 have the privileges of voting and seeking office in the PCN. Current ministries of the PCN include a group e-mail listserv for questions and concerns related to pediatric pastoral care, a website (www.PediatricChaplains.org), the annual Pediatric Chaplains Forum, and the Pediatric Chaplains Institute. Membership in the PCN also qualifies one to apply for the annual Wilbert Foundation Grant.

PLEASE NOTE: Unless you specify otherwise, your membership information, including contact information, is made available to other members of the PCN. Membership information in not given to anyone outside of the PCN.

Please check here if you want your information EXCLUDED ____