New
Renewal

 

Benefactor
$250
Patron
$150
Sponsor
$75
Household
$40
Individual
$15

 

 

Name(s):________________________________________________________________________

Address:________________________________________________________________________

City: ________________________________State___________________________Zip_________

Phone_________________________________

E-mail_________________________________

Please send this form with your payment to: Georgetown Historical Society or contact us for more information

PO Box 441 - Georgetown, Maine 04548 - (207) 371-9200

info@georgetownhistoricalsociety.org

 

 

 

 

 

 

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