Membership Application Form


      ____ Individual ($25)    ____ Family ($40)   ____ Life ($200)

$ _____ Bryan-Andrew House Restoration Fund (Optional)


Name(s)___________________________________________________

Address ___________________________________________________

Phone_____________________Email___________________________

_____I wish to volunteer as a museum docent or helper at the antique shop.


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Please print, fill out, and mail to:

Membership Committee
Orange Historical Society
P.O. Box 784
Orange, CT 06477