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Forest County
Historical Society

To become a member, please fill out the form and return with payment in the form of cash or cheque.

Name(s):______________________________ Date:_____ Address:________________________________________ City:_____________ State:___ Zip:_____ Phone:__________ Annual Dues- (circle one):
Active- $8.00 per person 
Contributing- Any amount over Active fee
Membership runs for one calender year (Jan 1 to Dec 31)
# of members:____ Amount enclosed:_______

Return to:
Anna Belle Motzer, Membership Chairman
P.O. Box 63
Endervor, PA 16322

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