MEMBERSHIP DRIVE NOW IN PROGRESS! AMBULANCE 2019-2020 MEMBERSHIP APPLICATION & CHAIR SERVICE WASHINGTON COUNTY CHAIR Circle Location: Washington Slovan I Make check/money order payable to: AMBULANCE & CHAIR SERVICE 75 Braden Street Washington, PA 15301 Date I Bentleyville $35 Individual. Married Couple. Family... .$55 .$65 (CHECK TYPE) 75 Braden St., Washington, PA 15301 Phone No. New Enclosed Payment Renewal Call (724) 225-8050 Twp, Boro, City or 1-800-244-0165 Expires December 15, 2020 Phone Number: I Name: I Address: I City: Call Membership Line for Brochure (724) 225-8238 Zip: Twp: ANCE AM SERVICE MEMBERSHIP DRIVE NOW IN PROGRESS! AMBULANCE 2019-2020 MEMBERSHIP APPLICATION & CHAIR SERVICE WASHINGTON COUNTY CHAIR Circle Location: Washington Slovan I Make check/money order payable to: AMBULANCE & CHAIR SERVICE 75 Braden Street Washington, PA 15301 Date I Bentleyville $35 Individual. Married Couple. Family... .$55 .$65 (CHECK TYPE) 75 Braden St., Washington, PA 15301 Phone No. New Enclosed Payment Renewal Call (724) 225-8050 Twp, Boro, City or 1-800-244-0165 Expires December 15, 2020 Phone Number: I Name: I Address: I City: Call Membership Line for Brochure (724) 225-8238 Zip: Twp: ANCE AM SERVICE