Membership Application

Join the Pintlala Historical Association
Please print and mail completed form & dues to:

Pintlala Historical Association
c/o Gary Burton
13812 US Hwy 31
Hope Hull, AL 36043

Name ___________________________________________________________

Address _________________________________________________________

City, State, Zip ___________________________________________________

Phone (Home & Office) _____________________________________________

E-mail Address ____________________________________________________

Areas of Interest __________________________________________________

If you are interested in genealogy, please indicate family surnames ___________

________________________________________________________________

$15.00 Annual Dues - Make checks to PHA.