THE HARLAN FAMILY IN AMERICA
Mailing List
[_] ADDRESS CHANGE [_] ADDRESS
CORRECTION [_] RECEIVING DUPLICATES
[_] PLEASE SEND NEWSLETTER BY E-MAIL (instead of snail mail)
[_] PLEASE ADD MY NAME
e-mail address:________________________________
Contributions
Please accept my donation of $ _____________ to help defray
[_]
newsletter expense and Association expenses.
I wish to contribute $________
to the Remembrance Fund
[_] in memory of
[_] in honor
of ________________________________________________
Make check payable to: The Harlan Family in America |
Mail to: The Harlan Family in
America - P.O. Box 1654 - Independence, MO 64055
Name_____________________________________
Address___________________________________
City_______________________ State______________ Zip___________
A Membership & Contribution Form that can be printed |