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 Miller
1118 East Prospect St, York, Pa. 17403
RENEWING MEMBERS:

Annual membership fees & this application form are due to the Financial Secretary by 1 August of each year.
Membership fees for renewing members are $25 before 1 september of each year.

MEMBERSHIP FEES FOR RENEWING MEMBERS ARE $35 AFTER 1 SEPTEMBER 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):________________________________