APPLICATION FORM  
Membership Dues (January-December)
Please check desired membership  
 Active Individual ($10)
 Active Family ($10)
 Youth (Under 18) ($2)
 Contributing ($15 plus)
 Group/Organizations ($25)
 Business/Professional ($100)
 Business/Professional ($150)
Your ad in all event programs
  Life Membership ($1,000)
  June Webb Burnett Society
(Extraordinary serviceand/oramount) 

DATE  ­­­_________ NEW            RENEWAL   NAME________________________________
ADDRESS_____________________________
  _____________________________________ 
CITY__________________________________
HOME PHONE _________________________  WORKPHONE _________________________  EMAIL________________________________
        
Please make checks payable to:      
       Historical Society of Carnegie PA

MONTHLY MEETINGS FIRST TUESDAY
  AT 6:30 PM