Welcome to the Cocalico Valley Historical Society

The Historical society of the Cocalico Valley

249 West Main Street, P. O. Box 193

Ephrata, Pa 17522

717 733-1616

Name ______________________________________________

Address ____________________________________________

City   ________________________  

State __________  ZIP ____________

Phone  (__________)  ___________________

MEMBERSHIP CATEGORY

(    ) Individual Member                                $20..00

(    ) Family Member                                     $30.00

(    ) Junior Membership (under age 17)    $10.00

(    ) Life Member (Individual)                     $500.00

(    ) Business Member                                 $75.00

Dues paid after October 1 by new members will be applied to the following year.

Payment to be made by check only.

Print and mail in this application with your payment to the above address. Thank you.