Membership Information

Membership Application
The French Azilum
P.O. Box 24 Wysox, PA 18854
TheFrenchAzilum@gmail.com
570-265-3376

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
P.O. Box 24
Wysox, PA 18854

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!

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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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