| Name: (Mr.) (Mrs.) (Ms) | ___________________________________________________ Date: ______________ |
| Address: | _______________________________________________________________________ |
| City/State/Zip: | _______________________________________________________________________ |
| My home phone and email address: | ( ) _______________ ______________________________________________ |
| Type of Membership: | 
|
Individual | $15 |
|
Family | $25 |
|
Contributing Individual | $40 | |||||
|
|
Student (age 18 or under) | $5 |
|
Corporate | $200 |
|
Contributing Family | $75 | ||||||
|
|
Life - Individual | $250 |
|
Life - Couple | $400 |
| I would like to make an additional contribution for: | ||||||||||
|
|
Museum Building Fund | $__________ |
|
Woodbridge Endowment | $__________ | |||||
|
|
Cheney Homestead Endowment | $__________ |
|
Manchester Historical Society Endowment | $__________ | |||||
|
|
Keeney Schoolhouse Endowment | $__________ |
|
Unrestricted | $__________ | |||||
|
|
I have enclosed a matching gift form. | Make checks payable to: Manchester Historical Society |
| I would like to do volunteer work and I am interested in helping at: | ||||||||||
|
|
Old Manchester Museum |
|
Cheney Homestead |
|
Keeney Schoolhouse | |||||
|
|
Manchester History Center | |||||||||
| I would like to help the Historical Society by: | |||||||||
|
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Being a docent |
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Fund-raising |
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Accessioning/cataloging artifacts | ||||
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Marketing/Publicity |
|
Special Events |
|
Entering catalog data on computer | ||||
|
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3rd Grade Tours (May) |
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Heritage Day (June) |
|
Open House (December) | ||||
|
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Newsletter |
|
Gardening/Handyman | ||||||
Other
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