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MEDWAY HISTORICAL SOCIETY
MEMBERSHIP ENROLLMENT FORM
Name: __________________________________________________
Street:
___________________________________________
Town:
______________ State: ______ Zip
Code: _______
Phone:
(______)__________ Email: ___________________
(check one):
______ New Membership ______ Renewal
Membership Category (check
one):
______
Senior/Student ($10.00)
______ Individual ($15.00)
______ Couple
($20.00) ______ Family ($25.00)
$_____________ Fee enclosed
Date: ___________________
Make Checks Payable to:
Medway Historical Society
223 Main Street
Medway, MA 02053 |