PITTSTOWN HISTORICAL SOCIETY

Membership application/renewal form
(print & mail to the address below)

q	$3 Individual	q	$2 Senior (65 & older)
q	$25 Supporter	q	$50 Benefactor
q	$15 Business

	Total (enclose check for this amount)
q	I would like to volunteer my time

  Name:

  Address:

  City, State, Zip:

  Telephone Number:

  E-mail address:

Make checks payable to: Pittstown Historical Society,

P.O. Box 252, Valley Falls, NY 12185