MONSON HISTORICAL SOCIETY, INC.

Membership Form

I want to be a member of the Monson Historical Society, Inc.

Name ______________________________________________________
Address_____________________________________________________	Telephone	________
Town ______________________________________________________	State____	Zip______
E-mail Address ______________________________________________
Interests ___________________________________________________

Please indicate a membership category & enclose a check made out to Monson Historical Society, Inc.

__ Individual (under age 18) $5ºº __ Individual (age 18 & over) $10ºº

__ Family $20ºº __ Life Membership $500ºº __Corporate Membership $50ºº

Print This Form & Return to - Membership,One Green St., Suite One, Monson, MA 01057

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