Membership Application
(Please
Print)
Name: ___________________________________________________________________
Address:__________________________________________________________________
City: _______________________________ State: _______ Zip:
______________________
Phone: _______________________
E-mail:
____________________________________
Membership Categories (please chek one):
____ Active: $20.00/year.
____ Family: $20.00, plus $1.00 for each additional family member per year.
Names of additional family members:
_______________________________________________
____ Contributing: $50.00 to $99.00 per year.
____ Supporting: $100.00 or more per year.
Please make your check payable to MSR&LHA and send it to:
MSR&LHA
c/o Art Dameron
56 Bedford Pl.
Yardley, PA 19067
USA
Checks must be in US$ and drawn on a U. S. bank. Send cash at your own risk.
Sorry, we cannot accept credit cards.
Multiple
memberships are welcome. MSR&LHA is a recognized Section 501(c)(3)
Tax Exempt organization by the internal Revenue Service. All
membership fees and donations are deductible from Federal income tax.