I want to join CoyleFriends!

The membership year extends from January to January

Name: _________________________________

Phone: ___________________

Address: _________________________________________________________

City: ________________________ State: ________  Zip: __________________

(__) $1  Under 12

(__) $10 Family

(__) $3 Senior Citizen

(__) $5 Individual

(__) $25 Patron

(__) $100 Benefactor

Please send this form with payment to CoyleFriends, 102 North Main Street, Chambersburg, PA 17201.

Make checks payable to CoyleFriends, or payment can be made by Visa or Mastercard.

Type of card __ Visa  __ Mastercard

Card number ________________________________________

Expiration Date ________________________

3 digit security code on back of card ______

Signature ______________________________________

CoyleFriends, 102 North Main Street, Chambersburg, PA 17201

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