Friends of Marilyn Adams Membership Application

Quinte Kin Home
Please print out and complete this form.

Friends of Marilyn Adams
Box 35, 528 County Road 19, Ameliasburg, Ontario, Canada K0K 1A0

MEMBERSHIP APPLICATION

Please PRINT or TYPE and remember to sign the form.

NAME		FMA #
ADDRESS:
CITY:	PROV. / STATE:	POSTAL CODE:
TELEPHONE:	E-MAIL:
NEW ____ RENEWAL ____7th TOWN # ____________ FMA # ____________ I am interested in volunteering ___		AMOUNT
YEARLY FEE*		$18.00**†
You may also join The 7th Town Historical Society for $5.00 (Canadian tax receipt will be issued)		$5.00
Donation to General Fund (Canadian tax receipt will be issued)
Donation to Trust Fund (Canadian tax receipt will be issued) Donations to the TRUST FUND are made under the Canada Revenue Agency Ten Year Rule
Donation to Library Acquisition Fund (Canadian tax receipt will be issued)
TOTAL
Membership runs for 12 months from the end of the quarter in which you join. *Applications from USA or overseas, please send US$. †1/3 of the fee is a donation under the 10 yr rule of CRA and goes to the TRUST, with a Canadian Tax Receipt issued for $6.00.
SIGNATURE: (Required by Canada Revenue Agency 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
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)