Membership Application Form


      ____ Individual ($20)    ____ Family ($40)   ____ Life ($200)

     ____ Benefactor ($500)   ____ Patron ($1,000)


$ _____ 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.


***********

Please print, fill out, and mail to:

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