Ravens Roost #41 - About Us - Membership Application

RAVENS ROOST #41

MEMBERSHIP APPLICATION

INSTRUCTIONS
Complete all Required Information for each applicant
(Families: please submit a separate application for each family member)
Complete this form and make out a check (for Regular Membership only) for $25* payable to:
Ravens Roost #41

Submit the completed form and check to the Roost #41 Financial Secretary:
Cyndi Rosenzweig
1118 East Prospect St, York, Pa. 17403
RENEWING MEMBERS:
Annual membership fees & application form are due to the Financial Secretary by June 1 of each year.

REQUIRED INFORMATION

Membership Type (Check One): Regular (at least 21 years old - $25) Junior (under 21 - Free)

NAME:________________________________________________________________

MAILING ADDRESS:_____________________________________________________________

HOME PHONE:__________________________

EMAIL:________________________________________________________________

DATE OF BIRTH (MM/DD/YYYY):______________________

GUARDIAN'S NAME (Junior Members Only):________________________________