P.O. Box 1317 Liberty, MO 64069-1317 USA 1-888-213-6949

Application for Membership

Fill out Form and Print It
Mail it to the address above with your check or Money Order made out to “Harp and Shamrock”

The Harp and Shamrock is a 501(c)(3) Tax Exempt Public Charity

   Type of Membership (check one):

Individual ($25.00)    Couple ($40.00)   

   Type of Shirt (check one per person):

T-Shirt    Polo ($10 additional charge per person)   

   Size of Shirt (check one per person):

XX-Large    X-Large    Large    Medium    Small   

   Method of Payment (check one):       Check    Money Order    Cash   

Note... Please make the check or money order out to "Harp and Shamrock"

Name:

Phone:

Mailing Address:

Other Phone, Address, Fax, E-Mail (optional):

Do not wait for acknowledgement.