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!