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WV State Civilian Conservation Corp Museum Association, Inc.
                                                                            Application for Membership

___________ Regular Membership -   $20 Annually

___________ Educator Membership - $10 Annually

___________ Student Membership   - $5    Annually

___________ Lifetime Membership -  $100


Name:________________________________________________________________________________   

Address:______________________________________________________________________________   

City:________________________________________State:__________________Zip:________________    

Phone:_____________________________  Email:_____________________________________________    

Signature ___________________________________________________________________

MAIL Form to:

WV State Civilian Conservation Corp Museum Association, Inc.
43 Quiet Dell School Road, Mt. Clare, WV  26408
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