YEAR: ______            

          Woodland Owners of the

          Southern Alleghenies (WOSA)

          Annual Membership Form

            Name ___________________________________________________________________________

            Address _________________________________________________________________________

            City, State, Zip ___________________________________________________________________

            Phone No. ____________________________   E-mail __________________________________

            # of Acres Owned ____________________    County _________________________________

            Do you, or have you had, a Forest Stewardship Plan? ____________________________

            Would you like a Forester (free of charge) to walk your property and discuss your

            concerns and goals? ______________

            Single: $15_______   Family: $20_______   Sponsor: $50_______   Associate $15:_______

                               Single and Family members are voting individuals or families who own forest land, and support WOSA.

                               Sponsor members are non-voting public or private organizations, which own forest land, or have a public or commercial

                                    interest in wood products, land or wildlife preservation, and support WOSA.

                               Associate members are non-voting individuals who do not own forest land, but endorse, and support WOSA.


            If family, please list other members:________________________________________________

            Amount enclosed $__________

            Make check payable to WOSA

            Mail to:  WOSA        P.O. Box 253        Everett, PA 15537

            Thank you for your support!!

            Laura Jackson, Membership Chair

  Woodland Owners of the

  Southern Alleghenies