	Lancaster County Bird Club
	Lancaster, Pennsylvania
	Founded December 8, 1937
	to secure the cultivation of public sentiment in the preservation of our native bird life.

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Lancaster County Bird Club Membership Form

Lancaster County Bird Club Membership Form - Year July 1, 2009 - June 30, 2010

Please print this form, and mail it in or bring to a Club meeting after completing it.

Membership dues enclosed for:

Mr. ______________________________________________________ Tel. No. (____)___________________________

Mrs./Miss/Ms. ______________________________________________________________________________________

Dependent Children (List only if this is a family membership; if more space is needed, list on the back.)

____________________________________________________________________________________________________

Address ____________________________________________________________________________________________

City, State, Zip ___________________________________________________________________________________

email address ______________________________________________________________________________________

Type of Membership: ____ New  ____ Renewal

Category of Membership: 
____$5.00 Student  
____$15.00 Regular (Per Adult)  
____$25.00 Family (Parents and dependent children.)
____$30.00 Sustaining (Per Individual)
Additional contribution for Club support, if desired, in the amount of $_____________

Contribution in Memory of:________________________________________ By;______________________________

Contribution in Honor of:_________________________________________ By;______________________________

Total amount enclosed $_____________   

Make check payable to Lancaster County Bird Club and mail form to:
Mr. Roger Stoner
1650 Princess Anne Drive
Lancaster, PA 17601-5631

Please enclose this form with your dues for proper membership credit and to keep our list of mailing addresses current. Membership dues and forms may also be given to Mr. Stoner at Club meetings. Membership dues and all contributions are tax deductible.

Please note: The Call Notes Research Issue for 2009 will be made available on our web site in order to save printing and mailing costs. If you would like to have a printed copy of the Research Issue please check below:

_____ Yes, I would like a printed copy of the Research Issue.