|
NAME:________________________________________
Street:
_________________________________________
City State
ZIP: ___________________________________
Phone: [
] ____________________
EMail
______________________________
Birthday:
Anniversary:
INTERESTS:
Please write on back of this application
[ ] Contributing Member: $25.00
[Payable Yearly]
[
] Lifetime Membership [65 & older]: $200.00
Please make
check payable to
Elizabeth Township Historical Society
and mail to:
Elizabeth
Township Historical Society
5811 Smithfield Street
Boston, PA 15135 |
