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!