| Please print this page and then complete it manually | APPLICATION FOR MEMBERSHIP |
| ANNUAL MEMBERSHIP FEES |
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| for regular members $ 28.00 | |
| for sustaining members 42.00 | |
| for life-time members 400.00 | |
| for students 14.00 | |
Please make cheque or money order payable to : |
The membership fee of $ _______________ is enclosed with the application for membership ___ |
| HISTORICAL SOCIETY OF MECKLENBURG UPPER CANADA | |
| The membership fee of $
_______________ will be mailed to the Treasurer ______ |
|
| I am hereby applying for membership in
the HISTORICAL SOCIETY OF MECKLENBURG UPPER CANADA |
|
| as a regular / sustaining member (please
delete as applicable) |
|
| Family Name:
______________________________________ |
|
| First Name:
______________________________________ |
|
| Profession:
______________________________________ |
|
| Address:
______________________________________ ______________________________________ |
|
| Phone: ________________________________ | |
| Please Print this Page and Mail it to us if you
wish to join Please Mail the completed Application to: HISTORICAL SOCIETY OF MECKLENBURG UPPER CANADA P.O. Box 24502 + 136 Orton Rd + Toronto, Ont. + Canada + M1G 3V8
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