The Bethel Memorial, Incorporated P.O. Box 809 Winchester, VA 22604

* * * * * * *

Please print. ____Renewal     ____New Member Mr./Mrs./Mr & Mrs./Miss/Ms./Dr./no title Name ___________________________________      Address _________________________________ City ______________State______Zip__________ Phone Home: ____________Work: ____________

Membership is open to all      those interested in the preservation, restoration and on-going programs of Old Bethel Meeting House.

Annual dues are: Individual .........$ 15.00 Couple .................25.00 Friend ..................50.00 Patron ................100.00

Contributions are gratefully received and tax deductible.

* * * * * * *

Enclosed is an additional contribution of $__________ for restoration. ____ Please contact me for a memorial gift. Would you like to become involved? Please indicate your interests. ____ Spring Event ____ Educational Program      ____ Fund Raising ____ Hospitality ____ Fall Event ____ Annual Meeting ____ Christmas Carol Sing ____ Special skills, services or           equipment I can volunteer.

* * * * * * *

Thank You