I wish to be a member of the Bethany Historical Society, Inc.
Name_______________________________________________________________________________
Address_____________________________________________________________________________
Phone Number________________________________________________________________________
Membership Dues:
___ Individual.............. $ 10.00
___ Family.................. $ 15.00
___ Sustaining............. $ 50.00 (individual or couple)
___ Life...................... $ 150.00 (individual or couple)
___ Organization......... $ 25.00
___ Business............... $ 50.00
___ Donation.............. $______
I am interested in serving on the following committees:
___ Collections ___ Fund Raising
___ Membership ___ Oral History
___ Programs ___ Publicity
Please make checks payable to: Bethany Historical Society
Mail to: Bethany Historical Society, 512 Amity Road, Bethany, CT 06524