Friends of Historic New Utrecht

New Utrecht Liberty Pole Association

 

Membership Application


     The Friends of Historic New Utrecht and the New Utrecht Liberty Pole Association

encourage you to join us in preserving our proud heritage. Help support our future events and exhibits. If you would like to become a member, please call (718) 256-7173, or print and mail this form with your check to:

 

Friends of Historic New Utrecht/New Utrecht Liberty Pole Association
1831 84th Street
Brooklyn, NY 11214-2914

 

□ $10 Annual Membership Fee (□ $15 Couples, □ $75 Lifetime, □ $100 Couples Lifetime) to Friends of Historic New Utrecht and/or

 

□ $5 Annual Membership Fee (□ $2 Seniors/Students, □ $10 Couples, □ $75 Lifetime) to the New Utrecht Liberty Pole Association.

  

Name ________________________________
Address ________________________________
City, State ________________________________
Zip Code _________________ - _____________
Telephone # (Day)       _______________________

(Evening) _______________________

(Fax)       _______________________
Signature ________________________________________
Date  ____/____/________

I wish to be notified of Friends meetings by:
U.S. Mail (Y) (N)
E-mail (Y) (N)
Provide address: ___________________@____________________