Become a Member

Name: (Do not hit return)

Email address:

Phone number:

Gender:

Female
Other

Age:

17 or under
18-20
21 or older

Which services are you interested in
(Check all that apply)

Psychotherapy?
Backrubs?
Confession and absolution of sins?
Emotional support?
Spiritual guidance?
Other:

Are you interested in becoming a Member-Plus Card Holder?

Yes
No

Are you interested in receiving information on becoming an altar girl for Reverend Higgins?

Yes
No


All memberships are subject to review.� The management retains the right to withhold and revoke any membership with or without reason. The free, basic membership does not cover all services.� Additional costs are subject to discussion.

All altar girls must be of legal age (18+).

Hosted by www.Geocities.ws

1