Colchester Historical Society
P.O. Box 112
Downsville, New York 13755
www.colchesterhistoricalsociety.org

2016 Application for Membership

Name______________________________________________________________

Address_________________________________________________________________

_________________________________________________________________________

Phone____________________________

Email_____________________________________________ I would like renewals and newsletters sent to this email address.

Categories: please check categories

Individual $15                 Senior-over age 55  $10              Student  $10

Special Categories:

Building Fund Contribution $______________ CHS has established a Building Fund with a future goal of purchasing a permanent home for the Colchester Historical Society Collections.

Memorial Gift-in memory of____________________________________________$__________

Gift Membership:

Name:__________________________________________

Address:________________________________________________

____________________________________________________________

Phone:_______________________Email_____________________

Please contact me, I would like to volunteer.

Please make your tax deductible checks payable to Colchester Historical Society.