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.