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   MEMBERSHIP 

 Please sign me up as an enthusiastic Nyack Indian supporter!

Printable application form

(highlight application below and print selection)

ANNUAL MEMBERSHIP FEES (please check  one)

Individual membership   $10________  Student Membership  $5_________

 Senior Membership (65 & older)  $8___________   

     Additional Corporate or Personal Donation  $___________

   Name: (please print)________________________________________________________________________

   Address: (please print)  Street:________________________________________________________________

               City   ___________________________State_______________________Zip ________________                                

                   Phone: (        )_________________________________________________   

                   Email address____________________________________________________________________
                                         

PLEASE ENCLOSE YOUR PAYMENT TO RECEIVE YOUR

 2007 NYACK INDIAN FOUNDATION GIFT!   

Mail Check or Money Order and application to:

THE NYACK INDIAN FOUNDATION, INC.  

P.O. BOX 804   

NYACK, NEW YORK 10960