7th Town Membership Application

Please print out and complete this form.

7th Town Historical Society
Box 35, 528 County Road 19, Ameliasburg, Ontario, Canada K0K 1A0

MEMBERSHIP APPLICATION

Please PRINT or TYPE and remember to sign the form.

NAME		MEMBERSHIP #
ADDRESS:
CITY:	PROV. / STATE:	POSTAL CODE:
TELEPHONE:	E-MAIL:
NEW ____ RENEWAL ____7th TOWN # ____________ FMA # ____________ I am interested in volunteering ___		AMOUNT
YEARLY FEE*		$5.00**
You may also join Friends of Marilyn Adams The FMA costs $18.00, $6.00 of which is a donation to the TRUST FUND under CRA 10 YR. Rule. Canadian Income tax receipts issued for ALL but $12.00 fee for Friends of Marilyn Adams.		$18.00
Donation to General Fund (Canadian tax receipt will be issued)
Donation to Trust Fund (Canadian tax receipt will be issued) Donations to the TRUST FUND are made under the Canada Revenue Agency Ten Year Rule
Donation to Library Acquisition Fund (Canadian tax receipt will be issued)
TOTAL
Membership runs for 12 months from the end of the quarter in which you join. *Applications from USA or overseas, please send US$.
SIGNATURE: (Required if joining FMA to allow $6.00 to Trust under the 10 year rule)
Please make cheque payable to: 7th TOWN HISTORICAL SOCIETY And mail to: Box 35, 528 County Road 19, Ameliasburg, Ontario, Canada K0K 1A0
IF JOINING FMA YOU MAY SUBMIT A LIST OF 6 SURNAMES YOU ARE RESEARCHING ______ Please include these names and my name and address in the annual list of surnames being researched (sent out with Quinte Kin in December)

FOR OFFICE USE ONLY: Date ________________________ Receipt Mailed ____________________