BERWICK HISTORICAL SOCIETY MEMBERSHIP APPLICATION

Part 1

Please enter the following information:

Name:

Address:

City: State or Province

Country:

Postal Code Telephone

E-mail Address Birth Date

Please check the category of membership that you desire.

$20.00 Annual Membership

$250.00 Life Membership (One-time payment)

$5.00 Junior Membership (Age 18 or younger)

I'm unable to be active in the Society at this time, but wish to help support the

Society's efforts with a contribution of $

Please print Part 1 of your membership application and click here to proceed to Part 2.

To clear the form press