Dorset Historical Society
Membership Application

Please print and include this form with your check payable to Dorset Historical Society

Name:
Mailing Address:
Town, State, Zip:
Phone:
Email:


Interested in volunteering?   Yes______ No______

Membership Levels ( January 1 - December 31 )

Regular: $35 per year ( Jan 1 - Dec 31 )
Supporter: $50 per year
Sustaining: $100 per year
Patron: $250 and above per year
Benefactor: $500 per year
Other: $ _________


Your dues and contributions are tax deductible.

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