
NAME: |
STREET: |
CITY/STATE: |
ZIP CODE: |
TELEPHONE: |
EMAIL: |
| TYPE OF MEMBERSHIP | PLEASE PRINT, FILL IN ALL INFORMATION AND SEND YOUR CHECK OR MONEY ORDER TO THE ADDRESS ABOVE PAYABLE TO: THE WARWICK HISTORICAL SOCIETY |
INDIVIDUAL-$10__________ |
|
FAMILY-$15_______________ |
|
STUDENT-$5______________
|