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Please print the following page and fill out membership info. Membership dues are $10.00 per person. Anyone in the household 18 and older needs to pay the membership fee if they wish to become a member. Anyone 17 and younger is free providing that a parent is a member. Membership drives runs from May 1st to June 30th. Anyone wishing to become a member after that date will then have to pay $20.00 per person 18 and older. Donations are also very appreciated. Membership can be returned to either the Fleet Bank Weatherly Branch, or mailed to the Greater Weatherly Ambulance Association Inc., 400 Carbon Street, Weatherly, PA 18255 NAME_________________________________________ ADDRESS______________________________________ City,State,Zip Code_______________________________ PHONE #_______________________________________ Place anyone else 18 and older on the following lines. _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ Place the names of children 17 and younger below. _______________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ Membership dues $10.00 per person 18 and older. Total amount enclosed______________________________ Additional Donations if any___________________________ |