To join Pioneer Mutual Hook and Ladder Society or to make a contribution, please print a copy of this application form, complete it, and send it with your tax deductible remittance to:

Types of Membership

Annual dues paying:...............Check one

Contributing (Pipeman).............$24 ( )
Sustaining (Engineer)..............$50 ( )

Cash Contributions:

Life (Foreman) One time...........$500 ( )
Patron (Assistant Chief)..........$750 ( )
Benefactor (Chief Engineer)......$1000 ( )

*Contributions toward Patron and Benefactor
 are accumulative.

Name:

 Address:

City, State, Zip: