Name_____________________________________________
Address___________________________________________
City/State/Zip_______________________________________
Phone No. (_____) - ____________-______________________
Annual Membership Fee: Individual Membership
$10.00 Family Membership $12.00
Check here
if application is: ___ New ___ Renewal
Family Plan
consist of Spouse and Family Members up to the age of 18 living at home
Name_____________________________________________
Name_____________________________________________
Name_____________________________________________
Name_____________________________________________
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Make checks
payable to YCRC and send to:
Karen Miller
568 Yale Street
York, PA 17403
(717) 846-3036