Name: (Mr.)(Mrs.)(Miss)____________________________________________ Date:_____________
Address:___________________________________________________________________________
City/State/Zip:_______________________________________________________________________
Class of Membership Desired:|
q |
Individual |
$15 |
|
q |
Family |
$25 |
|
q |
Contributing Individual |
$40 |
|
q |
Contributing Family |
$75 |
|
q |
Student (age 18 and under) |
$5 |
|
q |
Corporate |
$200 |
|
q |
Life – Individual |
$250 |
|
q |
Life – Couple |
$400 |
| q Museum Building Fund $_______ | q Woodbridge Endowment $______ |
| q Cheney Homestead Endowment $________ | q Society Endowment $ ______ |
| q Keeney Schoolhouse Endowment $ _______ | q Unrestricted $ ______ |
q 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:
q Old Manchester Museum q Cheney Homestead q Keeney Schoolhouse
I would like to help the Historical Society by:
q Being a docent q Accessioning/cataloging artifacts q Fund-raising q Entering catalog data on computer
q Marketing/Publicity q Gardening/Handyman q Special Events q Newsletter
q 3rd Grade Tours (May) q Heritage Day (June) q Open House (December)
q
Other ______________________________________________________________________________
Mail completed form to:
Manchester Historical Society
106 Hartford Road
Manchester, CT 06040