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