Site hosted by Build your free website today!

Join Our Club

Want to join our club? Well, we make it easy! Just fill out this form with all your information and someone will contact you to fill you in on the exciting details of being a Junior Civitan! For more questions, email Paul Vetrone and he'll get right back to you!

First Name
Last Name
Street Address
Phone # (Please include area code)
Email Address
Father's Name
Mother's Name
Health Card Number

* Don't live in Burlington? Contact Paul Vetrone to find a club near you!