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| PRINT THIS FORM, COMPLETE THE INFORMATION AND MAIL ALONG WITH YOUR CHECK OR MONEY ORDER TO: | The Kutztown Area Democratic Club P.O. Box #45, Kutztown, PA 19530-00045 |
PLEASE PRINT CLEARLY NEW MEMBER _______________ MEMBERSHIP RENEWAL_______________ Name __________________________________________________________________________________ Address ________________________________________________________________________________ Municipality _____________________________________________________________________________ Phone ______________________________________ E-mail Address ______________________________ |
Membership Type: (circle one) |
Student ($5) | Basic ($10) | Supporting ($30) | Sustaining ($50) |
If you would like your I.D.card mailed to you, please include a self-addressed, stamped envelope ..or pick one up at one of our meetings" (see calendar for meeting schedule) |
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