CANAL
SOCIETY OF NEW YORK STATE
Please
enroll me/us in the member classification noted below.
I/we have
enclosed $ __________ dues.____
Please
check category
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Individual
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$30.00
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Family (Life Partner /parent and child)
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$40.00
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Sustaining annual dues
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$45.00
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Institutional annual dues
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$55.00
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Name:
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Street:
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City:
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State:
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Zip:
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Phone(Home):
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Business:
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Business or Profession:
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Business Address:
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Introduced By:
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Mail a
copy of this form with check payable to the Canal Society of New York State to:
Michele D. Beilman, Executive Director
Canal Society of New York State
2527 Cherry Valley Turnpike
Marcellus, NY 13108
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