119 South Pitt Street
Mercer, PA 16137 ************************ Membership Application If you are interested in becoming a member of the MCHS; please print this page, fill out the form, and send a check or money order in US funds to the address above. Thank you for considering becoming a member. Name ___________________________________________________________________Address _________________________________________________________________
City ___________________________________ State ____________ Zip ______________
New _____ Renewal _____
PLEASE CHECK APPROPRIATE CATEGORY AND CIRCLE THE AMOUNT SENT.
| Type of Membership | 1 year | 2 years |
| ___ Senior Citizen Membership (over 65) | $6.00 | $12.00 |
| ___ Student Membership | $6.00 | $12.00 |
| ___ Individual Membership | $10.00 | $20.00 |
| ___ Family Membership | $15.00 | $30.00 |
| ___ Contributing Membership | $25.00 | $50.00 |
| ___ Patron Membership | $50.00 | $100.00 |
| ___ Sustaining Membership | $100.00 | $200.00 |
| ___ Life Membership | $200.00 | Once only |
Membership year runs January 1 to December 31