[__] $3 Student/Child
[__] $8 Senior Citizen
[__] $8 College Student
[__] $10 Individual
[__] $20 Family - If family membership, total persons at this household: _______
[__] $50+ Associate
[__] $150 Life Member (individual or family)
[__] $250+ Benefactor
[__] $1000 Patron
[__] Contribution (Tax Deductible): $_______
Name: ___________________________________ Phone: ______________
Address: ____________________________________________________
City/State: _______________________________ Zip: ________________
eMail Address: ______________________________________________
Please write clearly! Your information will remain in the
Strictest confidentiality. eMail addresses are used to facilitate
your access to the Members Only section of our Web Site.
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
And keep in mind, Membership in the FOPP makes a great gift! Celebrate a birthday, Christmas, New Years, holidays or Spring, with a gift to your friends (and your community).
If you would like a gift card sent in your name, enter YOUR name and address below.
"This membership is a gift from:"
Name: ___________________________________ Phone: ______________
Address: ____________________________________________________
City/State: _______________________________ Zip: ________________
A copy of the official registration and financial information may be obtained from the Pennsylvania Department of State by calling toll free, within Pennsylvania: 1-(800)-732-0999. Registration does not imply endorsement.
(040825)