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Rubicon Alumni Association

Membership Application
Name (First and Last) : _____________________________________________________________________________

How may we contact you about meetings and upcoming events?

Address: __________________________________________________________________________________________
City: ___________________________________

State: _______________

Zip Code: _________________________

Phone number: ______________________

Email: ________________________________________________

Person to contact in an emergency/phone number: _____________________________________________________

Which Rubicon program were you in? ___________________ When? ______________________________________

What volunteer activities are you interested in? (check all that apply)

I have learned that

____ Working at special events

every day you should

____ Sharing your story with people in treatment

reach out and touch

____ Serving on Alumni Association committees

someone. People love

____ Serving as a mentor to people in treatment

a warm hug or just a

____ Other - please specify: ____________________________

Please tear this page out,

fold, stamp, and mail
to the following address:
Rubicon Alumni Association
2000 Mecklenberg St.
Richmond, VA 23223

pat on the back.

Maya Angelou

Page 4

Rubicon Alumni Association Resource Guide

Please tear this page out,

fold, stamp, and mail
to the following address:

Place
Stamp
Here

Rubicon Alumni Association

2000 Mecklenberg St.
Richmond, VA 23223