MEMBERSHIP FORM
_____ $7.50 Associate membership 1 year
_____ $10 Active membership 1 year
_____ $25 Institutional membership 2 years
_____ $100.00 Lifetime membership
Name _______________________________________
Address______________________________________
City__________________ State________ Zip________
Phone_________________ Email__________________
Cell phone:____________________________________
Institution______________________________________
Date___________________________________________
Send to:
Janine Tiffany
Ten South Second Street, P.O. Box 1706
Reading, PA 19603-1706
PA4C Treasurer
Application document