Loyalhanna Grotto

Membership Application Form

Complete this application
Print it out
Verify that all information is correct
Send it along with your payment to:

Treasurer
Loyalhanna Grotto NSS, Inc.
P.O. Box 1204
Indiana, PA 15701


Name
Permanent Address
City
State
Zip Code
Phone

Temp or Work Address
City
State
Zip Code
Phone

E-mail Address
Grotto Number
NSS Number
Are you willing to help with rescues?
Yes No
Is this your primary grotto?
Yes No

Membership Fees: select ONE
NSS Members Regular, $10
  Family Associate, $5
Non-NSS Members Associate, $12
  Family Associate, $6
 
If there is a Regular or an Associate member in a household, then additional people at the same address can join at half price (no newsletter) as Family Dependent members.
 
  Currently the dues structures encourages membership in the NSS. For more information about the NSS contact any grotto officer or visit: www.caves.org