Washington County Historical Society
Membership Application
167 Broadway
Fort Edward, NY 12828
Name _________________________________ Date ____________
Address _________________City ________________ State
____ ZIP____
Telephone
( )
______________ email ___________________________
Do you have an off-season
address? (e.g. start: January; end: March)
Address _________________
City _______________ State____ ZIP _____
Away Date: ___________________ Return Date: ____________________
Membership Categories
|
___ Benefactor $500+ |
___ Family (#___) $25 |
|
___ Sustaining $150 |
___ Individual $20 |
|
___ Contributing $75 |
___ Senior $15 |
|
___ Patron $50 |
___ Student $15 |
|
|
|
I
would like to include a gift of $________ for __Library Operations, __ General
Fund.
Please note that the WCHS membership year is January 1 thru
December 31. New memberships received after November 1 will be honored for the
following year. Annual memberships and donations are tax deductible to the
extent allowed by law.