The Cheshire Historical Society
The Hitchcock=Phillips House
43 Church Drive Cheshire, Connecticut 06410 USA Telephone: 203-272-2574

MEMBERSHIP FORM FOR THE CHESHIRE HISTORICAL SOCIETY - BECOME A MEMBER TODAY!

More about MEMBERSHIP AT THE CHESHIRE HISTORICAL SOCIETY

Name: ____________________________________________

Telephone Number: (_____) _________________

Mailing Address: ________________________________________

Town: ______________________________ Zip Code: _____________

E-Mail: _________________________@_____________ Would you like to receive our newsletter by e-mail? YES / NO

Enclosed dues of $ _____________ for membership in

Your check payable to: "The Cheshire Historical Society, Inc."

Classification of Dues:

___ Individual $20.00
___ Family $25.00
___ Business / Professional $40.00
___ Supporting $40.00
___ Senior Citizen $10.00
___ Life $200.00

We wish to keep dues to a minimal amount. However, dues alone do not cover the society's operating costs. We hvae added a line for any additional contribution you may care to make.

___ Additional Contribution $__________

All contributions are tax deductible to the extent by law.

Events and meetings are held at the Hitchcock-Phillips House, 43 Church Drive Cheshire, CT unless noted otherwise.

Call 203-272-2574 or e-mail for more information.

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