Pioneer Total Abstinence Association

of the Sacred Heart

Application for Membership

Name……………………………………………………………

Address………………………………………………………….

……………………………………………………………………

Telephone……………………………email……………………. .

Date when alcohol last consumed (if ever)…………………..

I wish to become a Temporary/Permanent (delete as appropriate) member of The Pioneer Total Abstinence Association. I have read and understand the contents of the leaflet

What it means to be a Pioneer

Completed forms can be handed to Father Toner or

any member of the Kilmore Pioneer  Council