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Colchester Historical Society 2021 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.
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