Application to Join or Renew Membership to the

Wantagh Preservation Society

www.Wantagh.LI, Copyright 2001 Long Island Dot

Please print this application, fill it out, and mail it with payment to the address shown below.

Thank you for your support!

Name:

 

Street:

 

City, State, Zip:

 

Phone Number:

 

Email:

 

Status (please check one):

___New    ___Renewal
 

Type (please check one):

___Individual $10    ___Family $20    ___Friend $30    ___Patron $50    ___Fellow $100
 

Wantagh Preservation Society

PO Box 132

Wantagh, NY 11793

 

Revision Date: 2009-11-08

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