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Seymour Historical Society
P.O Box 433 Seymour, Conn. 06483
2013 Membership Form
NAME: __________________________________ E-MAIL ______________________________
ADDRESS: _______________________________ TOWN/ZIP CODE _____________________
MEMBERSHIP TYPE: _________________________
$25 Annual Individual $15 Annual Senior (Over age 62) $10 Annual Junior (Under age 18)
$45 Annual Family $150 Life Membership (Individual) $200 Life Membership (Business)
ADDITIONAL DONATION: _________ (Those who give at least $30 ABOVE the cost of membership dues total will receive a Seymour Historical Society tote bag OR a T-shirt. Please indicate your choice:)
Tote Bag: ________ T-Shirt: ______ (Circle color/size) Red
Black S M
I would like to do volunteer work for the Seymour Historical Society:
______ DOCENT: Serve as a guide when museum is open to public or during programs.
______ INTERIOR MUSEUM ASSISTANCE: Light cleaning, such as vacuuming and dusting.
______ PROGRAMS: Help choose guest speakers and distribute promotional materials before programs.
______ CURATOR ASSISTANCE: Help organize and set up exhibits.
______FUNDRAISING: Help plan events that raise money for the Society.
______RENOVATION: Help organize work by contractors and oversee their work.
______ YARD WORK: Help maintain our property by doing weeding, leaf pick-up, etc.
______ EDUCATIONAL OUTREACH: Teach students about Seymour history.
______ I have other skills that could help the Seymour Historical Society. They are:
The Society mails out flyers announcing upcoming programs. Do you wish to receive these?
_____ Yes, please send flyers and other announcements through the U.S. mail.
_____ Instead of mailings, please send program information to the email address listed on this page.
_____ No, please take my name off of all mailing lists and do not send me emails.