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Application Form

Please complete and return to student’s Theology instructor or mail to address below.

Check one or more of the following as they apply to you:

I would like to become a CORE MEMBER of the GREEN AND GOLD for the very FIRST TIME. Please send your e-mail address to Mary Doher at Mary.Doher@experian.com.
Enclosed is the first-and-only time fee of $5 for a NEW CORE MEMBER. You will receive the 54-day Rosary Novena to Our Lady prayer book.
As a CORE MEMBER, I would like to pray for a specific faculty/staff member of the Pius X family who will later be assigned to me.
I would like to become an HONORARY MEMBER of the GREEN AND GOLD. My only obligation is to pray for the Pius X family every day.
I would like to take a regular time slot for Adoration of the Blessed Sacrament on FIRST FRIDAY ADORATION in the Pius X Chapel (8 a.m. to 3 p.m.). The best hour (or half-hour) for me is _________________________(on the hour, i.e. 8-9 a.m.).



E-MAIL ADDRESS___________________________________________________________________


NAME OF STUDENT_______________________________GRADE_______PERIOD_____________

NAME OF THEOLOGY TEACHER___________________________________ROOM_____________


Please return to your student’s Theology instructor. If you do not have a student but would like to support Pius X through prayer and adoration, please send the completed form to Rhonda Litt, 1101 North 79 Street, Lincoln, NE, 68505-2008. You can also call her at 402-467-1102 (daytime/work) or 402-489-3819 (evening/home) with questions. Thank you and God Bless!


Pius X • 6000 A St. • Lincoln, NE 68510 • 402-488-0931 • Fax: 402-488-1061

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