Friends of Beck’s Mill, Inc.
(501 C-3 Not For Profit Organization)
P.O. Box 288
Salem, Indiana 47167
Membership Application
I hereby request to become a member of the Friends of Beck’s Mill, Inc., and shall be granted all the rights and privileges of membership. I agree to adhere to all by-laws, regulations and policies.
(Please Print)
Name________________________________________________________ M F (Circle one)
Spouse____________________________________________________________________
Address________________________________________E-mail_______________________
City___________________________State______________Zip___________-____________
Home Phone_______/________-______________Bus Ph______/_______-______________
Fax Number_______/________-______________Profession_________________________
Date of Birth_____/_____/________Applicant’s Signature___________________________
___________________________________________________________________________
Membership Certification
(Bottom portion to be completed by Friends of Beck’s Mill, Inc. Officer)
Officer’s Signature___________________________________________________________
Title_______________________________________________________________________
Date____________________________ Type (Circle one) New Member Renewal
Membership Fee Schedule
Student Member $10 Adult Member $15 Family $25 Corporate $100
Application may be mailed to: Friends of Beck’s Mill