| Moultonborough
Historical Society, INC |
| Organized in 1958 : Incorporated -
September 26, 1994 501(c) (3) Non-Profit Corporation |
| P.O.
Box 659 |
| Moultonborough
: NH 03254 |
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| Renewal or New Membership
2006 |
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| Please check the 1 Year (or Life) Membership for
2005 you
wish, for the amount of money you have enclosed. |
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STUDENT Membership (Full-Time Student 26 years of age or under) $2.00 |
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Individual Membership $8.00 |
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BRONZE Individual/Family Membership $25.00 |
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SILVER Individual/Family Membership $50.00 |
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GOLD Individual/Family Membership $75.00 |
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LIFE Individual Membership (One time fee) $100.00 |
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BRONZE LIFE Individual Membership *$25.00 |
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SILVER LIFE Individual Membership *$50.00 |
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GOLD LIFE Individual Membership *$100.00 |
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*Annual
fee for LIFE Members only for this distinguished recognition |
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| Please PRINT and complete the form below and
mail in with
your payment. Thank you! |
Last Name
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First Member First Name
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First
Member MI
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Mailing Address
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Second Member First Name
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Second Member MI
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Town
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Comments or list
names of other family members – use back of form for more room
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State
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Zip Code
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Email Address
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| Mail to: |
| Fran
Vincent |
| c/o
MHS Membership Chairman |
Make Checks Payable to: Moultonborough
Historical Society |
| P.O.
Box 1148 |
| Center
Harbor, NH 03226 |
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to Membership Page
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