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Membership Application

Please fill out the following form, click on the Register button and mail the appropriate dues amount to the address listed below.

    First Name (required): 

   Middle Name (required): 

     Last Name (required): 

Street Address (required): 

          City (required): 

         State (required): 

      Zip Code (required):  Example "12345-1234

     Telephone (required):  Example "123-456-7890"

    Your Email (required): 

          Year (required):  

Surnames and subjects for genealogical exchange:

Count: 275

Geographical location:

Count: 275

Select which type of member you wish to become: Individual Membership ($30.00/Year)Family Membership ($40.00/Year)Student Membership ($15.00/Year)Institutional Membership ($40.00/Year)Life Membership ($300.00) Input this code: captcha Once you click on the "Register" button, your application will be submitted via e-mail to the Society. We now provide two options for payment: 1) Pay online using our Paypal account (Using menu options Shop/Marketplace/Society Membership) 2) Promptly remit the appropriate dues amount by mail to: Tulpehocken Settlement Historical Society 116 N. Front St., PO Box 53 Womelsdorf, PA 19567-0053

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