Cottonwood Crossing Chapter of the Santa Fe Trail Association

							Cottonwood Crossing Chapter of the Santa Fe Trail Association
Membership Application / Renewal Form, Calendar Year 20_____.

Annual Membership Dues are $15.00, whether Individual or Family.

Please Send Dues To:            New Member_______      Renewal_______

Kent Becker                                     Your
                                Name:_________________________________
Box 83 290th Road
Durham, KS 67438                     Spouse’s
                                Name:_____________________________

Phone 620-732-3341                   Street or P.O.
                                Box____________________________

                                City:____________________State_____Zip_______

                                Phone:_____________________________________

                                E-Mail:_____________________________________


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