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MEMBERSHIP APPLICATION -
2010
The Northampton County Historical and
Genealogical Society
101-107 South Fourth Street, Easton, PA 18042
Please use this form to become a member for the
year
2010
BENEFACTORS..................................................................................$1000
and up
PACESETTERS...................................................................$
500 - $999
MIXSELL
CIRCLE.................................................................$
150 - $499
HISTORIC
CIRCLE................................................................$
100 - $149
PENN'S KINFOLK
(Family).....................................................$ 50
-
$ 99
MUSEUM PROTECTOR
.........................................................$ 40 -
$ 49
My membership contribution for 2010 is
..............................$____________
If upgrading, please check here ___
My membership should be in the following name and
address: (Please print)
Name_______________________________________________
Address_____________________________________________
City/State/Zip
Code____________________________________
Telephone____________________Email____________________
I would like to make a special donation for:
A Memorial
Gift..............$_______
General Donation $_________
The Library
Fund...........$_______
Garden Fund.................$_______
New
Museum.................$_______
Please return this form with your check made out
to NCHGS.
Contributions are tax deductible under 501-c-5 of
the IRS Tax Law
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