MHS

Maytown Historical Society

NAME: _________________________________________________

  ___ New Membership
___ Renewal

MAILING ADDRESS:
Street __________________________________________________
PO Box ________________________________________________
City ___________________________________________________
State _______________________ZIP CODE __________________

PHONE NUMBER (        ) ____________________________
EMAIL ADDRESS __________________________________

Please indicate which membership you are seeking
ANNUAL __________ ($10.00/yr)               LIFE __________($50.00)

 

PRINT this form, complete and send along with a check payable to:
Maytown Historical Society
PO Box 293
Maytown, PA 17550-0293

Thank you for supporting our Society…and its work!