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SOCIETE FRANCAISE DE BIENFAISANCE 
(FRENCH BENEVOLENT SOCIETY)
DE NEW YORK
Fondee en 1809.      Incorporee le 18 Avril 1819
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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