APPLICATION FOR MEMBERSHIP

____ Membership for the year of ____($10/year) ~~~~~~~~~~~~~~~~~~~~~$10.00

____ Membership for life~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~$100.00

Last name ___________________ First Name__________________ Middle Initial ___

Address _________________________ City _______________ State ____ Zip______

Tel. No. ______________ Special Intrests or talents ____________________________

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If the above is a gift please provide your information below as Donor

Last name ___________________ First Name__________________ Middle Initial ___

Address _________________________ City _______________ State ____ Zip______

Tel. No. ______________

 

Make all checks payable to Squan Village Historical Society and mail to:

Squan Village Historical Society
Membership Chairman
PO Box 262
Manasquan, NJ 08736

Squan Village Historical Society

PO Box 262, Manasquan, NJ 08736
Tel. 732-223-6770