Membership Registration

July 1, 2021 to June 30, 2022

 

Please complete this form designating your choice/choices of membership:

 

Name _______________________________________

 

Street _______________________________________

 

City _________________________________________

 

State ___________________Zip__________________

 

Phone _______________________________________

 

E-mail _______________________________________

 

Date of Birth __________________________________

 

School System/District ______________________________________________

 

LOCAL DUES:   Annual _______________ $10.00

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                          Life     _______________ $100.00

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Mail to: Patricia Waring, Treasurer

              209 Brandt Lane

              Altoona, PA 16601

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Amount Enclosed $ _______________

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In order to reduce postage costs to the BCCPASR, your membership card can be picked up at the semi-annual luncheon and will not be mailed unless requested.

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