MEMBERSHIP APPLICATION
FOR
WEST MANCHESTER TOWNSHIP
HISTORICAL SOCIETY, INC.

Corporation/Business___________________________________________________

Name (Individual)______________________________________________________
Spouse (Family)_______________________________________________________

Address______________________________________________________________
City__________________________________State____________Zip____________
Phone(Home)___________________(Work)________________________________
E-Mail_________________________Fax___________________________________

Type of Membership    ______Active
                                    ______Associate
                                    ______Honorary

Class of Membership    ______Yearly Individual $20.00
                                    ______Yearly Family* $25.00

                                    ______Yearly Individual Senior(65+) $15.00
                                    ______Yearly Senior Family** $18.00

                                    ______Life Individual $200.00
                                    ______Life Family* $250.00

                                    ______Life Individual Senior(65+) $150.00
                                    ______Life Senior Family** $180.00

*Family membership includes spouse and children under 18 years of age.
**Senior Family membership includes spouse of any age.

Memberships are valid January 1st through December 31st.

Mail this form and make checks payable to: West Manchester Township Historical Society, Inc.
1998-A Carlisle Road
York, Pa. 17404

Any questions, call 764-3107.

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For Society use only: Check#_________________     Cash__________________________
Date accepted for membership:________________    Certificate issued________________
                                                                                   Card(s) issued__________________
Processed by:______________________________  Date:_________________________