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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 |