wpe1B2.jpg (4111 bytes)

Membership Application for the Frederick A. Cook Society

I would like to join the Society.  Please enroll me in the following membership category:

box.gif (72 bytes) $15 Individual box.gif (72 bytes) $20 Couple box.gif (72 bytes) $25 Family

box.gif (72 bytes)  $4 each:  Poster of 1996 Symposium or Belgica Symposium

(additional up to 4 in one tube, $.50 each)

NAME

____________________________________________
ADDRESS ____________________________________________
____________________________________________
CITY ____________________________________________
STATE

_____________

 ZIP _____________
COUNTRY ____________________________________________

 

Mail to:

Frederick A. Cook Society
Sullivan County Historical Museum
P.O. Box 247
Hurleyville, NY   12747

Note:  Please send any foreign money orders payable in U.S. dollars.

 

Return to the "About the Frederick A. Cook Society" page.

Copyright 2005 - The Frederick A. Cook Society