MINISINK VALLEY HISTORICAL SOCIETY
GENERAL MEMBERSHIP ORDER FORM

Please Check one of the following categories:

Membership Categories

check box Junior Historian (up to 18) - $5.00

check box Individual Membership - $15.00

check box Family & Friend Membership - $20.00

check box Patron & Business Membership - $50.00

check box Stephen Crane Contributing Membership - $100

check box John B. Jervis Canal Engineer Sustaining Membership - $250

check box Stephen St. John Canal Hotel Museum Sponsor - $500

check box Martinus Decker Patriot Benefactor - $1,000

Additional donation:

check box Enclosed is an addition donation: $
Total:

$

Please make your check or money order payable to:
Minisink Valley Historical Society

Name:

  

Address:

  

City:

  

State:

  

Zip Code:

  

Telephone:

  

E-mail Address:

  

Please mail to: Minisink Valley Historical Society
Post Office Box 659, Port Jervis, New York 12771-0659