Membership Application

Name:    _______________________________________________________________

Address:   _______________________________________________________________

         _______________________________________________________________

Phone:    (     ) ________________________________________________________

Email     _______________________________________________________________

    Annual Family............................ $20.00

    Annual Individual: ......................$15.00

    Business or Organization: ............$40.00

Print and mail contributions with this page to:
Chenango Canal Association, Inc.
P. O. Box 125
Bouckville, New York 13310

All contributions are fully tax deductible. The Chenango Canal Association Inc is a 501 (c) (3) non profit.