Membership Form

New

Renewal

Please enter my Haddam Historical Society Membership in the following category:

Benefactor $250.00
Sustaining $100.00
Contributing $ 50.00
Family $ 30.00
Individual $ 20.00
Senior Citizen $ 10.00
Student $ 10.00
Business $ 50.00
Name:
Address:
City:
State:
Zip Code:
Phone
Fax:
Email 1:
Email 2:
Membership to the Haddam Historical Society is tax deductible
My employer will match my membership contribution (Ask your human resources if your company participates in a matching gift program)
Please print this form and mail it with your check payable to:
The Haddam Historical Society · PO Box 97 · Haddam, CT 06438