MEMBERSHIP APPLICATION

Name _________________________________________________________
Address   _______________________________________________________
City/State/Zip  ___________________________________________________
*Phone (optional)  _________________________________________________
*E-mail (optional)  _________________________________________________
Date:  _________________________
*optional phone & e-mail

 _____Single/Family $5.00

 _____Contributor $25.00

Make checks payable to: UAWA

Mail to:
Upper Allegheny Watershed Association
C/O Potter County Conservation District
107 Market Street
Coudersport, PA 16915