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Membership Application for the FEBT

Start my membership in Friends of the East Broad Top today. I've enclosed payment for the membership classification I've circled below:

REGULAR ($30*) FAMILY ($35*) SUSTAINING ($60)
ASSOCIATE ($100) LIFE ($500) STUDENT/SENIOR ($25*)

(* A $5.00 surcharge for foreign members applies.)

Please use the space below to provide us with your name and complete mailing address, as well as a summary of the payment you enclose with this membership application. If this is a gift membership, please provide the name and address of the person receiving your gift here, and provide your name and address on a separate piece of paper. Please do not send cash. Please make all checks payable to Friends of the East Broad Top.

NAME  
 
COMPLETE MAILING ADDRESS  
 
 
 
 
 
E-MAIL ADDRESS (if any)  
 
Dues Amount  
 
Please send your completed membership form (and payment) to

FEBT Membership Office
c/o Peter A. Clarke
10428 Carlyn Ridge Road
Damascus, MD 20872

FEBT Restoration Fund Donation (optional)  
 
Total Payment Enclosed  
 


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