Membership Information

Membership Application 
French Azilum, Inc.
c/o Deborah Courville, Treasurer

637 Doolittle Hill Road
Laceyville, PA 18623
TheFrenchAzilum@gmail.com
570-265-3376 

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: 


______________________________________________


Website Accessibility
French Azilum | thefrenchazilum.com Facebook Map

Board Docs

Home Contact