Print Application

TREASURER, LEBANON HISTORICAL SOCIETY

P.O. BOX 18

LEBANON, NH 03766

Please enroll me as a member. I enclose one year’s dues (circle one)

$5.00 (Senior)

$10.00 (Active)

$15.00 (Sustaining);

$50.00 (Corporate)

$150.00 (Life membership)

NAME__________________________________________

STREET_________________________________________

CITY/TOWN_____________________________________

STATE_________________________ZIP______________

E-MAIL_________________________________________

(  ) This check also includes a donation.