2010 Membership Form

Name: __________________________            E-mail: _____________________

Address: ________________________            Town/Zip: ___________________

Type of membership: ______________

Dues:      $25 Annual Individual                              $15 Annual Senior (62+ years)
                  $10 Annual Junior (under 18 years)   $45 Annual Family
                  $150 Life membership (individual)    $200 Business Sponsorship

Capital Fund Donation, if desired: _______________

I am interested in doing volunteer work for the historical society:

____ Docent (on duty when museum is open to public, or during special programs)

____ Interior Museum Maintenance (mostly cleaning; no heavy work)

____ Programs (help plan or promote programs or trips)

____ Fundraising

____ Grant Writing (assist the president and treasurer)

____ Educational Program (teach students about Seymour history)

____ I have other skills that could help the society. Please explain below:

___________________________________________________

___________________________________________________

I do/do not want to continue to receive information about Seymour Historical Society events:

____ Please continue to mail me fliers and other announcements.

____ Please send program information to e-mail address listed above.

____ Please take my name of the Seymour Historical Society mailing list.