Membership Category:
O $ 5.00 Student- in school (annual payment)
O $ 20.00 Individual (annual payment)
O $ 25.00 Family - includes children up to age 18 (annual payment)
O $300.00 Life - Individual (one time payment)
O $375.00 Life - Family (one time payment)
O $250.00 Annual Corporate Sponsor (annual payment)

Amount Enclosed: $__________

Name: _________________________________________

Address: ________________________________________

______________________________________________

Phone Number: ____________________

Email: ____________________

Print out and mail to:
Lynn-Heidelberg Historical Society
6751 Madison Street
PO BOX 73
New Tripoli, PA 18066