MEMBERSHIP APPLICATION and DONATION FORM

Please print screen and mail to:

H. Reid Bader

Treasurer, NYSCBS

207 Seneca Creek Rd
West Seneca, NY 14224-2347

Membership Fees:

Individual Membership - $10.00 annually

Family Membership - $10 plus $1 per additional family member annually

Individual Lifetime Membership -  $150.00

Family Lifetime Membership - $200.00

New York State Covered Bridge Society Membership Application

NAME(S):  ___________________________________________________________

                    ____________________________________________________________

                    ____________________________________________________________

                    ____________________________________________________________

ADDRESS:  ___________________________________________________________

                      ___________________________________________________________

City / State / Zip:  ______________________________________________________

Or Country Postal Code:  ________________________________________________

To make it easier to contact you about changes or cancellations:

     Phone Number: ______________________________________________

     Email address: _______________________________________________

Total Fee enclosed:  $                                     

Any monies above membership fees shall be considered a donation.

All  donations are deductible as we are a 503b Chartered Charitable Organization.

Thank you and Welcome

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