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PANTHER CREEK VALLEY FDN
NO.9 MINE & MUSEUM


Application for Membership


June 1, to-June 12th the following year


Non-Profit Organization
Federal ID No. 23-256-3958



_______Renewal ..................... ______New Membership .............. ______Donation




TYPES OF MEMBERSHIP:


Regular Member: Has all the rights and voting privileges…………………………………………$10.00


Corporate Members:

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:

Panther Creek Valley Foundation
No. 9 Mine & Museum
P.O Box 287
Lansford, PA 18232-0287
(570 645 7074)


Visit us on the Internet at www.no9mine.com


President: David Kuchta