Fitzwilliam Historical Society

Membership Application Form

Please check one of the following:

New Member

Renewal (Current Member)

The Fitzwilliam Historical Society uses dues to pay for overhead costs of the Blake House Museum, special programs and promoting Fitzwilliam History.  Members will receive a newsletter and invitations to special events.  Please check the box next to which type of membership you are applying for:

  Single                            $10.00

  Couple                          $15.00  

  Junior (18 & under)     $3.00

  Family                           $20.00

  Lifetime (each)             $100.00

  Business                       $30.00

  Sustaining                     $25.00

NAME:___________________________________________

TELEPHONE NUMBER:_____________________________

MAILING ADDRESS:_______________________________

________________________________________________

WINTER MAILING ADDRESS (IF DIFFERENT FROM ABOVE):

________________________________________________

________________________________________________

E-MAIL ADDRESS:________________________________

We are always looking for volunteers.  If you are interested in helping out, please

Include your phone number and let us know how you would like to help:

________________________________________________________

________________________________________________________

________________________________________________________

Please return this form and your dues to:

Fitzwilliam Historical Society

P.O. Box 87

Fitzwilliam, NH 03447

Make checks out to:   Fitzwilliam Historical Society