Peter Wentz Farmstead Society Membership Form

Fill out this form, click the Print button below to print it out, and send it to:

Peter Wentz Farmstead Society
P.O. Box 679
Worcester, PA. 19490-0679
Please make checks payable to Peter Wentz Farmstead Society.

First Name Last Name
Street Address City, State, and Zip
Home Phone Number Work Phone Number
E-Mail Address   
Select if:Wentz descendant  Schultz descendant
Select one:New Member  Please renew my membership

Select one:Student$10.00
 Individual$20.00
 Senior Family (both over 65)$25.00
 Family Membership$30.00
 Life Member$500.00
 Business$100.00
 Additional donation$ 
 Total amount enclosed$ 

Apply my additional donation to the fund checked below:
 Special Projects
 Scholarship (for students and interns)
Furnishings
 Other (specify below)
 

Please contact me about your volunteer activities