The Cheshire Historical Society
Hitchcock Phillips House
43 Church Drive
Cheshire, Connecticut 06410 USA

Telephone: 203-272-2574

BECOME A MEMBER OF THE CHESHIRE HISTORICAL SOCIETY

Print out this form and mail it to:

The Cheshire Historical Society
P.O. Box 281
Cheshire, CT 06410

Name: ____________________________________________

Telephone Number: (_____) _________________

Mailing Address: ________________________________________

Town: ______________________________ Zip Code: _____________

E-Mail: _________________________@_____________

Enclosed dues of $ _____________ for membership in

"The Cheshire Historical Society, Inc."

Classification of Dues:

___ Individual $15.00
___ Family $20.00
___ Business / Professional $30.00
___ Supporting $35.00
___ Senior Citizen $10.00
___ Life $150.00

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.

Call 203-272-2574 or e-mail edwinkania@cox.net for more information.

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