MARYLAND  FREESTATE  TREASURE  CLUB
MEMBERSHIP APPLICATION

To join, print out this page, complete the information and
enclose a check for $25.00 made payable to: Maryland Freestate Treasure Club.

Mail to: Charles Blenkner, 9943 Harford Road, Baltimore, MD 21234
( or bring the application to the monthly meeting )

The membership fee extends membership to the applicant's spouse and children under the age of 16.

Name:_________________________________________________________________

Address:_______________________________________________________________

City: _____________________ State:______________________ Zip:_______________

Telephone Number: ______________________________________________________

Email Address:__________________________________________________________

Spouse's Name:_________________________________________________________

Children's Names ( Under 16 ): _____________________________________________

______________________________________________________________________

Park Permit Numbers:  You: ___________________  Spouse: _____________________

Occupation:_____________________________________________________________

Hobbies:_______________________________________________________________

Programs you would like to see the Club present:
______________________________________________________________________

I would be glad to assist the Club by:__________________________________________

Club Use Only:

Paid:_____________ Check:_______________ Date:_____________________