Dorset Historical Society
Membership Application
Please print and include this form with your check payable to Dorset Historical Society
| Name: |
| Mailing Address: |
| Town, State, Zip: |
| Phone: |
| Email: |
Interested in volunteering? Yes______ No______
Membership Levels ( January 1 - December 31 )
| Regular: | $35 per year ( Jan 1 - Dec 31 ) |
| Supporter: | $50 per year |
| Sustaining: | $100 per year |
| Patron: | $250 and above per year |
| Benefactor: | $500 per year |
| Other: | $ _________ |
Your dues and contributions are tax deductible.
Dorset Historical Society
PO Box 52 ·
Route 30 at Kent Hill Road
Dorset, VT 05251 USA ·
802-867-0331 · Fax 802-867-0412
E-mail:
www.dorsetvthistory.org
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