Membership Information

The French Azilum, Inc. 

MEMBERSHIP APPLICATION

Thank you for wanting to be a Member of The French Azilum. Members are our greatest assets, and we welcome you happily to our expanding group of friends, supporters and volunteers.

Please print, then fill out this application and return it along with your payment to:

The French Azilum

c/o Deborah Courville, Treasurer

637 Doolittle Hill Road

Laceyville, PA 18623

You will receive a notification by mail of our receipt of your membership donation, which may be used for tax purposes.

Thank you very much again, and we look forward to seeing you at the site!

_________________________________________________

Name:_________________________________________

Address:________________________________________

               ________________________________________

Email & Phone:___________________________________

Membership Level (tick appropriate one):

______Individual ($25)         _______Family ($40)   

______Supporter ($75)          _______Contributor ($100+)

______Sustainer ($200+)     _______Benefactor ($500+)

 _______Corporate ($1000+)

IF YOU WOULD LIKE TO VOLUNTEER AT THE SITE, PLEASE INDICATE BELOW. THANK YOU!

YES, I would like to help out, especially with: 

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