Membership Application Form Please fill out and return with payment to Penn York Camp. Please note that your membership will not be accepted unless you agree with Penn York Camp’s Statement of Faith. Be sure to mark on the front, which level of membership you are applying for. Membership Prices
Name: _________________________________ Address:_______________________________
Gold Member $600 (Annual Renewal $500)
Address 2: ______________________________ City:___________________________________
Member Plus $250 (Annual Renewal $150)
State:________ Zip:_______________________ Phone:_________________________________
Basic Member $125 (Annual Renewal $25) If you would like to become a member of Penn York Camp. Simply mark which level of membership you are applying for and then fill out the application on the reverse side. Memberships are subject to the approval of the Penn York Camp board of directors. Payment will be refunded to anyone, whose membership application is not approved.
Penn York Camp & Retreat Center 266 Northern Potter Rd. Ulysses, PA 16948 (814) 848-9811 www.pennyork.com
[email protected] Email:__________________________________ I have read and am in agreement with Penn York Camp’s Statement of Faith. I Agree
I Disagree
Signature:_______________________________ Date:___________________________________ Payment By Credit Card: Visa
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Card # _______-_______-_______-_______ Name As On Card: ____________________________________ Expiration Date: _____________
3 digit security code _________