The Historic 1897 Firehouse membership form

MEMBERSHIP INFORMATION

MEMBERSHIP APPLICATION / RENEWAL FORM

*Calendar year membership January - December
*Open to all who pay dues and support objectives
*Those joining for the first time after Oct. 1st will be enrolled for entire subsequent year
*Carries voting rights
*Membership cards will be sent only upon request
*Includes quarterly newsletter
*Dues are tax-deductible to the fullest extent allowed by law

Mail to:

The Historic 1897 Firehouse
P.O. Box 103
Elmira, N.Y. 14902-0103

__ New Membership

__ Renewal

NAME:_______________________________________

ADDRESS:____________________________________

CITY:___________________ STATE:____ ZIP:_______

PHONE:(____)___________________DATE:_________

__Student	$2.00	__Contributor	$25.00
__Individual	$6.00	__Patron	$100.00
__Family	$10.00	__Donation	$_____