MEMBERSHIP APPLICATION

Family Name:                                  First Name:                                        Spouse:

Street:

City:

State, Zip:

Phone:

Children’s Names:

E-Mail Address:

I hereby make application for membership in, and agree to conform to the bylaws or amendment thereof in the PENN DUTCH PACERS VOLKSMARCH CLUB INC., and with the rules &  regulations of the AVA and IVV and in application I certify the above.

Date:

Signature:

Circle One:

New    Renewal

All membership fees are due in June!

Circle One:

$10 • 1 year

$18.00 • 2 years

$25.00 • 3 years

CHECKS TO:  Penn Dutch Pacers Volksmarch Club Inc., ATTN: Membership,

PO Box 7445, Lancaster PA  17604-7445

I will help with:

Awards Table [    ]

Registration [    ]

Trails [    ]

Food [    ]

Publicity [    ]

Checkpoints [    ]

Where needed [    ]