The South Hadley Historical Society

P.O. Box 387

South Hadley MA 01075

413-536-4970

http://home.comcast.net/~southhadleyhistoricalsociety/index.html

Email: SouthHadleyHistoricalSociety@comcast.net

Membership Application: _____ New _____ Renewal

Please check one below:

_____ Student $ 5.00 per year
_____ General 15.00 per year
_____ Contributing 25.00 per year
_____ Family 35.00 per year
_____ Sustaining 50.00 per year
_____ Patron 100.00 per year

Non-membership Donation $ _______________

Name: ______________________________________

Street: ______________________________________

City: _______________________________ State: __________ Zip: _____________

Phone: ______________________________Email: ________________________________

Date: _______________________________

Completed membership forms and dues may be given to any Officer or sent to:

South Hadley Historical Society

P.O. Box 387

South Hadley, MA 01075