Eastern Penn
Mushroomers
NAME:
_______________________________________
ADDRESS:
P.O. BOX: ________________
CITY:
STATE:
____ ZIP CODE:
___________________
PHONE: ________________________________ E-mail Address:
_________________________________
DUES:
(Select one)
Family
Membership
$20.00
Individual
Membership
$15.00
Make check
payable to:
Eastern Penn Mushroomers
Please indicate
your interests:
Learning Mushrooms
Eating Wild Mushrooms
Mushroom Walks
Mushroom Photography
Mushroom Art
Mushroom Dyeing
Cooking with Wild Mushrooms
Cultivating Mushrooms
I hereby release
the Eastern Penn Mushroomers and any officer or member thereof from any
legal responsibility for injuries or accidents incurred during or as a
result of any field trip, excursion, or meeting sponsored by the
association.
APPLICANTS SIGNATURE:
DATE: ____________
Return application and check to EPM Membership, C/o
Cheryl Dawson, 393 Waters Road,York, PA. 17403
If any questions, call or write 717-846-1225: email:
EPMClub@gmail.com