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Individual_________________________________________________ |
$15.00 |
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Family____________________________________________________ |
$25.00 |
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Life______________________________________________________ |
$200.00 |
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Benefactor_________________________________________________ |
$500.00 |
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Patron____________________________________________________ |
$1,000.00 |
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Name_____________________________________________________ |
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Address___________________________________________________ |
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Telephone#________________________________________________ |
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Historical Interest___________________________________________ |
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Dues Enclosed______________________________________________ |
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Make checks payable to: Orange Historical
Society