Friends of Midland
P O Box 7442
Steelton, PA 17113

Printer-Friendly Membership Form

If you would like to renew or join the Friends of Midland, enclose $10.00, print (Ctrl+P), fill out and return the form below to: Friends of Midland, PO Box 7442, Steelton, PA 17113. For contributions in addition to or instead of membership, check the box and write in the amount. Donations are needed and welcomed.

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Last name __________________________       First name____________________________

Address ______________________________         Phone number_(_____)______________

City ____________________________     State/Zip ___________/___________

E-mail address____________________ Fax ______________________ Cell_______________

Membership ___$10.00 per person       Additional Contribution___$_______________

Check number ____________ Money order___________ Date_______________
Do not send cash.
Check if you are available to volunteer at the Midland site________

Official use: ________________________ Date sent: ____________________________

The Friends of Midland is a non-profit organization. Contributions are tax deductible under IRC Section 501(c)(3). Friends of Midland is properly registered in Pennsylvania as a charitable organization. A copy of the registration and financial information may be obtained from the Pennsylvania Department of State by calling toll-free within Pennsylvania 1-800-732-0999. Registration does not imply endorsement.

internet form/modified April 4, 2004