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(Please Print)
 
Name: ___________________________________________________________________
 
Address:__________________________________________________________________

 
City: _______________________________ State: _______ Zip: ______________________
 
Phone: _______________________     E-mail: ____________________________________

Membership Categories (please chek one):

____    Active:  $25.00/year.

____    Family:  $25.00, plus $1.00 for each additional family member per year.
             Names of additional family members:
             _______________________________________________

____    Contributing: $50.00 to $99.00 per year.

____    Supporting: $100.00 or more per year.

Please make your check payable to MSR&LHA and send it to:
    MSR&LHA
    c/o Art Dameron, Membership Secretary
    56 Bedford Pl.
    Yardley, PA 19067
    USA

Checks must be in US$ and drawn on a U. S. bank.   Send cash at your own risk.
Sorry, we cannot accept credit cards.

Multiple memberships are welcome. MSR&LHA is a recognized Section 501(c)(3) Tax Exempt organization by the internal Revenue Service.  All membership fees and donations are deductible from Federal income tax.

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This page last modified or verified on December  10, 2015