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Please print this form and mail
to: Friends of Job Lane House, Inc., P.O. Box 720, Bedford, MA 01730
Name: ___________________________________________________________
Address:__________________________________________________________
City: ________________________________State:_________Zip:___________
Tel. No.:_________________Email*:__________________________________
*Optional
Membership Levels (please
check one):
| Single,One Year, $5.00 | Single, Life Membership, $50.00 | ||
| Family, One Year, $8.00 | Family, Life Membership, $80.00 |
Are you a (please check one):
| Lane Descendant | Dutton Descendant |
Make check payable to Friends
of the Job Lane House, Inc.
| Received: | Processed: |