MEMBERSHIP APPLICATION


Check your membership category below, Please make checks payable to THE
HISTORICAL SOCIETY OF SCHUYLKILL COUNTY.   Membership contributions are tax
deductible by the IRS.
Send to THE HISTORICAL SOCIETY OF SCHUYLKILL COUNTY
14 North Third Street
Pottsville, PA  17901


-------INDIVIDUAL               $20.                    ______PATRON            $100.
____HUSBAND & WIFE              $30.                    ______BENEFACTOR        $250.
____FAMILY                      $35.                    ______BUSINESS          $250.
____STUDENT                     $10.                    ______LIFE              $500.
____CONTRIBUTING                $50.    


IF YOU ARE INTERESTED IN BECOMING A VOLUNTEER THEN PLEASE CONTACT THE
SOCIETY AS TO WHAT COMMITTEE ASSIGNMENTS ARE AVAILABLE, OR CHECK BELOW:

____I AM INTERESTED IN BECOMING ACTIVE ON A COMMITTEE, PLEASE CONTACT ME.

AMOUNT ENCLOSED________

NAME ___________________________________

ADDRESS_________________________________

CITY____________________________________                        STATE__ ZIP_________

e-mail______________________________