Eastern Penn Mushroomers

A club dedicated to the study and enjoyment of wild mushrooms

2010 membership Application

 

Name:

 

Address:

 

City:

 

State:

 

Zip

 

 

 

Phone:

 

e-mail:

 

 

2010 Dues

Eastern Penn Mushroomers                         $15.00  Individual         $ 20.00  Family                

Make check payable to Eastern Penn Mushroomers. 

Forward signed application check to Bill Miknis, 3119 Parker Drive, Lancaster, PA 17601.

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, foray or meeting sponsored by the club.

 

Applicant Signature:                                                                           Date:                     

Applicants Signatures:________________________________________________________________________________________    Date:________

 

If any questions, call or write 717-898-8897: email: eyes4morels@verizon.net