MEMBERSHIP FORM 2008
Please fill out form and return to KCRC with payment for New membership or to renew your membership. THANK YOU!
Mail to: KCRC, PO Box 42, Kempton, PA 19529
NAME(S) ________________________________________________________________________________
ADDRESS _______________________________________________________________________________
CITY __________________________________ STATE ________________ ZIP ____________________
PHONE ________________________________
Please check all that apply.
- RENEWAL MEMBERSHIP $5.00 per person $_____________
- NEW MEMBERSHIP $5.00 per person $_____________
- REGULAR LIFETIME $75.00 per person $_____________
- SENIOR LIFETIME $50.00 per person $_____________
- KEMPTON COUNTRY FAIR DONATION $_____________
- KEMPTON COMMUNITY RECREATION CENTER DONATION $_____________
Total Enclosed $___________
Yes I would like to volunteer to help with – WEDDINGS/EVENTS --- FAIR --- COMMUNITY DAY (PLEASE CIRCLE ONE OR ALL)
www.kemptoncommunityrecreationcenter.com
