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Sanbornton NH 03269
MEMBERSHIP APPLICATION
DONATIONS IN ADDITION TO DUES ARE TAX DEDUCTIBLE
Please renew my membership: ________ I wish to become a new member: ________
Name: __________________________________________________________
Mailing Address: __________________________________________________
City, Sate & Zip Code: _____________________________________________
Telephone #:______________________________________________________
Email: __________________________________________________________
Summer Mailing Address: __________________________________________
City, Sate & Zip Code: _____________________________________________
Telephone #:______________________________________________________
Annual Dues:
________ Family - $20
________ Institutional - $25 Life Membership:
________ Individual under 65 - $200
________ Individual over 65 - $125
________ Couple - $200
Unrestricted Donations in Addition to Dues (Tax Deductible):
________ $15 to $49 - Trailblazer
________ $50 to $99 - Pathfinder
________ $100 or more - Voyager Restricted Donations in Addition to Dues (Tax Deductible):
________ Lane Tavern Entrance Renovations
________ Snowroller Shed
________ TOTAL
Please make checks payable to: Sanbornton Historical Society
Mail to: Sanbornton Historical Society, PO Box 204, Attn: Membership, Sanbornton, NH 03269
e-mail: info@lanetavern.org
This document maintained Jack
Potter, 603-528-1990, info@shakerwoodsfarm.com.
Shaker Woods Farm at Point Comfort, 8
March 2008