Yes, I want to help preserve the Covered Bridges for our future! |
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| Annual Membership |
| Individual ...................................... $ 5.00 __ |
| Family ............................................ 10.00 __ |
| Business ......................................... 20.00 __ |
| . |
| Life Member ................................ 100.00 __ |
| I would like to make a donation of $ _____________ |
| Please check the level of membership above and make checks payable to: "CCCBA" |
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| Name _____________________________________ |
| Address ____________________________________ |
| City ________________________________________ |
| State ________ ZIP ___________________________ |
| Phone (_____) _______________________________ |
| E-Mail _____________________________________ |
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| Mail This Form to: |
| Columbia County Covered Bridges Association 529 Zaner-Rohrsburg Road, Orangeville, PA. 17859 |