SDFM Membership Application Form

Mail  To:         South Dorchester Folk Museum, Inc.
3347 Golden Hill Rd.
         Church Creek, MD 21622

   NAME: ________________________________________________
   ADDRESS: _____________________________________________
                   ______________________________________________
   TELEPHONE NO.: _______________________
   E-MAIL ADDRESS: ______________________
   YOUR SPECIAL INTERESTS: ________________________________
   __________________________________________________________
   MEMBERSHIP CATEGORY (Please fill in all that apply):
    _______LIFE MEMBER - $500.00    _______BENEFACTOR - $100.00
    _______FAMILY - $15.00     _______INDIVIDUAL - $10.00
    _______JUNIOR OR STUDENT - $5.00

   Special Donation: $___________        Total Enclosed: $___________

(New members paying dues the last two months of the year will be paid for the following year)
     Your contributions to The South Dorchester Folk Museum are tax deductible.
                                                                                                                                                               (Rev. 11/7/03)