Membership Form

Historians of Sterling Township

 

 Name: _____________________________________________________     Date: _______________________


Address: __________________________________________________________________

City/State: __________________________________________________     Zip: ________________

Phone: _________________________________     Cell: __________________________

 

 

Email: ______________________________________________________________________

 

Alternate Address (If Applicable): ________________________________________________

____________________________________________________________________________

 

 

Dues $20 per person, $35 per couple   

Checks to be made to:

 

H.O.S.T.

P.O.B. 48

Sterling,Pa 18463

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