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SOCIETE FRANCAISE DE BIENFAISANCE (FRENCH BENEVOLENT SOCIETY) DE NEW YORK Fondee en 1809. Incorporee le 18 Avril 1819 -------------------- HOPITAL FRANCAIS (FRENCH HOSPITAL) 450-458 WEST 34TH STREET NEW YORK MEMBERSHIP BLANK Date______________________ Please enroll my name on the Membership list of the French Hospital: Member............. paying $10.00 to $25.00 per year Sustaining Member.. " $25.00 to $100.00 " Patron............. " $100.00 to $500.00 " Donor.............. " $500.00 to $1000.00 " Name_________________________ Business Address_____________ Residence____________________ Proposed by__________________ Please give business address as well as residence