Old Munichburg
Association
PO Box 105806
Jefferson City, MO 65110

New/Renewing Membership Form

Name__________________________________________

Address________________________________________

City, State_______________________ Zip____________

Phone__________________________________________

E-mail__________________________________________
We prefer to use e-mail to contact members about meetings and other activities. We do not share e-mail addresses with anyone.

If a business, name of business_______________________________________________

Renewing member?________ New member?_________

Membership, at $35
(paid annually each January)    $___________

Additional contribution           $___________

Total enclosed                         $___________

Make check payable to Old Munichburg Association. Return this form and check to:
            Old Munichburg Association
            PO Box 105806
            Jefferson City, MO 65110

Regular monthly meetings are held on the last Wednesday of the month, at 7 p.m., in the Carpenters Building, 230 W. Dunklin St. (corner of Dunklin and Broadway).

Thank you!