Application for Membership in the Empire Chapter A.M.C.A.

Any new membership will now be applied to the 2021 roster

Thank you for your support

Please print your name and address. Include your spouse's name for family membership

** Please send a copy of your current National Membership Card and a self addressed stamped envelope! **

Name: ________________________________________________

Spouse's Name: _________________________________________

Your AMCA Number: _____________________________________

Street: ________________________________________________

City: __________________________________________________

Zip Code: ______________________________________________

Email Address: __________________________________________

Phone Number: _________________________________________

Dues $15.00 Per Year. Make Checks Payable to "EMPIRE CHAPTER, A.M.C.A."Membership year is january 1 through Dec 31. Spouse membership at no extra cost if you have a national family Membership. Note : We cannot process your Empire Chapter membership application without your National A.M.C.A number. It is a requirement of the National A.M.C.A to be a member in order to join a Chapter. Send Application to:   

Karen Benson 10971 County Line Rd Forestville, NY 14062 (716) 934-3137 krnbenson5@gmail.com