Please Join Us!

Play Your Part Support The Arts

Membership Application

Name: ______________________
Address:_____________________
____________________________
____________________________
Telephone:__________________
E-Mail:______________________

Type Of Membership:(Please Circle)

Individual - $15.00 + 1 Free Pass
Family - $25.00 + 2 Free Passes
Student Special - $10.00 + 1 Free Pass
CENTURY CLUB MEMBER - $100.00 Total Enclosed:_______________
Please make your check payable to:
NCCAH
Send to:  NCCAH
               POB 472
               Shamokin, PA 17872

or call us at 570-644-6570 ext 130