Membership & Donation Form

Please make checks payable to

Belmont Historical Society

c/o Jane McLetchie, Treasurer

180 Dutile Road

Belmont, NH 03220

Belmont Historical Society invites your involvement in any of the following ways.

State

Zip

Fax #

(tax deductible)

Membership dues cover January 1, 2008 through January 1, 2009

Thank you for your support!

On your BROWSER click file, print to print this form, and mail to address above with check payable to the "Belmont HIstorical Society".

Name

Address

City

Telephone #

Email Address

Annual Membership Family $15.00

Annual Membership (1 person) $10.00

Monetary Donation of

Other Donation