Apply by Mail - Nickerson Family Association

Nickerson Association Membership Form

Print out your completed application and mail it along with a check to:

Membership Chairperson
c/o Nickerson Family Association, Inc. P.O. Box 296
North Chatham, MA, 02650-0296
U.S.A.

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Name

First Last

Place of Birth

Date of Birth

Name of Spouse

Name 1

Date of Birth

Name 2

Date of Birth

Name 3

Date of Birth

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Enclosed is a check or money order for my membership dues (please check one): USD funds only

Annual Single Membership

$45.00

Annual Family Membership

(Husband and Wife) (Add $10.00 per child 18 or under)

$75.00

Number of Chidren under 18

x $10

Annual Sustaining Membership

$500

Lifetime Membership

$750.00

Total Dues:

Print out your completed application and mail it along with a check to:

Membership Chairperson
c/o Nickerson Family Association, Inc. P.O. Box 296
North Chatham, MA, 02650-0296
U.S.A.