B.C.H.R.&L.F.  Membership  Application

Name: ___________________________       Categories of Annual Membership:

Address: _________________________              ___ Individual, $22

____________________________________________                    ____  Family, $27

City/State: ________________________              ___ Senior Citizen $17                                                

Zip:___________ Phone: ____________               ___ Patron, $ 100

                                                                                                                        ____  Corporate / Business,                                                      $250

email: ___________________________                ___  Lifetime, $1500

 Membership contributions are tax deductible

All membership categories are entitled to                                       ____  New Member

receive all Foundation publications.                                                 ____  Renewal

Please Mail to: Membership Chairperson, BCHR&LF  1235 Third Avenue, Freedom, PA 15042