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Fort Daniel Foundation, Inc.
2009-10 Annual Membership
Application
Membership Type:
� Individual
$15.00 �
Family $25.00 (children to 18)
� Student
$10.00
�
Sustaining $100.00
� Lifetime
$300.00 �
Corporate Available
Date:
___________20__
Name: _________________________
Eligible Family Members: ____________________________
Address:
______________________City: ___________________State: ________ Zip:
___________
Phone Numbers H:
___________________ W: ___________________ C: ____________________
E-Mail Address:
_______________________ Emergency Contact:
__________________________
Phone:
___________________
Signature: ___________________________________
Please make check or money order
payable to FDF (Gwinnett Archaeological Research Society).
_ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Receipt for FDF Contribution
Date: ____________
Name:
___________________________
Check No. ______ $ ___________
Type:
�
Individual �
Family �
Student�
Sustaining �
Lifetime
Mail top
of form with check or money order to:
FDF Membership
Form FDF 001 Rev.9-2009
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