Legal Defense Fund Form:

Name: ______________________________________

Address : ____________________________________

City: _____________________ State: ___ Zip:______

Phone: ____________________

Email: _______________________________________

Are Your Willing To Volunteer? Y / N

Interests: _____________________________________

Legal Defense Fund:

____ Supporter: $200

____ Defender: $500

____ Preserver: $1000

____ Other Contibution: $_______

(please make checks payable to: Shawnee Preservation Society)
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Instructions: Print this form, fill it out and mail to:

Shawnee Preservation Society
P.O. BOX 517
Shawnee On Delaware, PA
18356