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Application for Membership
Please print copy of this page and mail to address at bottom. Thank You!
New ___ Renewal ____
Name:___________________________________________________
Firm:____________________________________________________
Street:___________________________________________________
Town / City:______________________________________________
State:____ Zip:___________ Phone:__________________
Email:_________________________________
___ Check here if you wish to receive mailings via email.
Please enroll me in (Please check)
____ Life Member $500
____ Sustaining $100
____ Contributing: $ 50
____ Patron $ 25
____ Family $ 15
____ Individual $ 10
____ Organization $ 10
____ Student $ 5
____ Senior Citizen $ 5
____ I would like a list of pulications that are for sale
____ I am interested in becoming a society volunteer Phone: __________
____ My employer matches gifts to cultural institutions. Enclosed is my Matching Gift Form.
Corporate Memberships
____ Contributor $ 50
_____ Corporate Donor $150
_____ Corporate Benefactor $300 +
Annual Memberships are tax deductible to the extent allowable by law.
Make checks payable to:
Washington County Historical Society
167 Broadway
Fort Edward, New York 12828
518-747-9108
email: wchs@together.net