NO.9 MINE & MUSEUM
Application for Membership
June 1, to-June 12th the following year
Federal ID No. 23-256-3958
TYPES OF MEMBERSHIP:
Silver $100 to $500
Gold $501 to $1,000
Platinum $1,000+
NOTE: Membership year runs from June 1st through June 12th of the following year.
Name. ___________________________________________________________________________
Last ................................. First ....................................................Mi.
Address__________________________________________________________________________
Street .............................................City ............................... State ......... Zip
Telephone:___________________________
Email_______________________________
Thank you for your exceptional support of our organization. We need and appreciate your help
Please remit the entire page to:
No. 9 Mine & Museum
P.O Box 287
Lansford, PA 18232-0287
(570 645 7074)
President: David Kuchta