Pawtuckaway Beekeepers' Association

PAWTUCKAWAY
BEEKEEPER'S ASSOCIATION
APPLICATION FOR MEMBERSHIP

Please fill out this form, print it, and mail it with your check to the address below.

DATE:
NAME:
STREET:
TOWN:	STATE: ZIP:
E-MAIL:
TEL#:
# OF COLONIES:
MEMBERSHIP IS: (select one)	NEW RENEWAL GIFT
Check here if you would prefer to receive the PBA newsletter by e-mail: Make check payable to PBA or Pawtuckaway Beekeeper's Association and mail with completed form to: Moe L'Heureux, Treasurer PBA, 83 Hanover St., Manchester, NH 03101

I HAVE ELECTED TO ENCLOSE AN ADDITIONAL $15.00 ($20.00 per Family) FOR MEMBERSHIP IN THE NEW HAMPSHIRE BEEKEEPERS' ASSOCIATION. [Include in PBA check or include separate check.]