MEMBERSHIP APPLICATION FORM
Name: ____________________________________________________
Address: _________________________________________________
__________________________________________________________
Phone Number: ___________________________________________
Email Address: ___________________________________________ Circle Type of Membership:
ADULT (age 18-59 yrs.) $ 12.00 per yr.
SENIOR (60+
yrs.) $ 10.00
per yr.
FAMILY (parents
plus children under 22) $ 25.00 per yr.
STUDENT
(under 22 yrs.) $ 5.00 per
yr.
LIFETIME MEMBER
- ADULT (age 55+ yrs.) $120.00
once
Number of Members:_____________ at
$______________
Number of Members:_____________ at
$______________
Total Amount Enclosed:
$______________
Mail or deliver this form to:
Solanco Historical Society
Attention: Treasurer
1932 Robert Fulton Highway
P.O. Box 33
Quarryville, PA 17566
THANK YOU FOR JOINING AND SUPPORTING THE
Southern Lancaster County Historical Society!
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