Complete this application for membership and make a difference today! Workflow Email Subject First Name Last Name Address1 Address2 City State Select State AL AK AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY ND OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY Zip Code Email Address Phone Alt Phone Best Time to Reach You Best Time to Reach You? Morning Afternoon Evening I would like to help with: I would like to help with Blood Drives Blood Pressure Screenings CareLink Thrift Sales Fundraising Events Gift Shop Newsletter Scholarships I agree to uphold the purpose and policies of the Auxiliary. I am willing to pay the membership fees in one of two ways: I agree to uphold the purpose and policies of the Auxiliary. I am willing to pay the membership fees in one of two ways: Select option Annual membership fee of $10 per year Lifetime membership of $100 (Lifetime members do not pay annual fees once your lifetime membership is established) Mail completed application and check made payable to the Kirby Auxiliary to: Kirby Auxiliary Membership 1000 Medical Center Drive Monticello, IL 61856 You will be contacted by a committee chairman to coordinate a time for you to volunteer. We like to keep all volunteers informed with important news, scheduling and opportunities to help by email. Send Message