Join the PCN

To be a member of the PCN for the year 2008, send this completed form and your check for $50.00 to:  

Chaplain Del Farris

Pastoral Care, Mail Slot 206

Arkansas Children's Hospital

800 Marshall Street

Little Rock, AR 72202

PEDIATRIC CHAPLAINS NETWORK

MEMBERSHIP APPLICATION

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.

(Note: Our Avery labels allow 4 lines of 30 characters/spaces each.)

Name and Preferred Mailing Address, as they should appear on a mailing label:

____________________________________________________________

____________________________________________________________

____________________________________________________________

____________________________________________________________

Daytime Telephone: _____________________

Fax Number:____________________________

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 and are payable by check or money order.

All members have the privileges of voting and seeking office in the PCN. Current ministries of the PCN include a group e-mail listserve for questions and concerns related to pediatric pastoral care, a website (www.PediatricChaplains.org), an occasional newsletter, and the annual Pediatric Chaplains Forum.

PLEASE NOTE: Unless you specify otherwise, your membership information, including contact information, is made available to other members of the PCN--on an ACCESS file, and/or a membership directory. OK to include you? ____Yes ____No