Summit Historical Society

Please Join Us

Summit Historical Society Membership Application

Your membership will help to support the work of the Society and is tax
deductible. It also enables you to receive our newsletter - The Historian

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SUMMIT HISTORICAL SOCIETY
Menbership Application

Dues for 2012-2013

__ Life $200

__ Benefactor $100

__ Patron $50

__ Family $25

__ Individual $20

__ New __ Renewal

__ Ms. __ Mrs. __ Mr. __ Mr. and Mrs.

Name ____________________________________

Street ____________________________________

City ________________________ State ________

Telephone _________________ Zip ____________

Checks payable to: Summit Historical Society
Mail to: Box 464, Summit, NJ 07902-0464