Membership Form

FALLS VILLAGE-CANAAN HISTORICAL SOCIETY

Membership Form

                                                        Single Membership…………….….$15.

                                                        Couple Membership…………….…$25.

                                                        Friends of the Museum……….    …$100. and up

                                                        Business/Professional………  …….$50.

If you have not sent in your annual dues payment, or desire to become a member of the Society, please mail your check payable to The Falls Village-Canaan Historical Society, to the Society at P.O. Box 206, Falls Village, CT  06031.  Please fill out the form below if you would like to be a member.

Name__________________________________________________

Phone__________________

  Address___________________________________________________________________________

Type of Membership________________________________________

Donation Amount_____________

Amount Enclosed__________

Donations are always appreciated and are fully tax deductible.