| 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 |
