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Equinunk Historical Society
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Membership Application
Equinunk Historical Society
PO Box 41, Equinunk, PA 18417-0041
Name: Mr.__ Mrs.__ ______________________________________________________
Mr.__ Mrs.__ ______________________________________________________
Mailing Address:
City____________________________________ State____ Zip__________________
(plus 4 if possible)
Telephone #: ( )_________________ Email ______________________________
Local Address ______________________________ Telephone__________________
City ___________________________________ State____ Zip__________________
(plus 4 if possible)
Category: Individual -($10)____ Family - ($18)____ Life - ($125)_____
Please call on me to volunteer____ Interests_______________________________
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Date Paid___________ Amount__________ Expires____________
CONSIDER GIVING A GIFT MEMBERSHIP IN EHS
JUNIOR MEMBERSHIPS AVAILABLE AT $2.00
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