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Sanbornton Historical Society
Lane Tavern, 520 Sanbornton Square, Route 132, Sanbornton Square
Sanbornton NH 03269


MEMBERSHIP APPLICATION

DONATIONS IN ADDITION TO DUES ARE TAX DEDUCTIBLE


Please renew my membership: ________ I wish to become a new member: ________

Name: __________________________________________________________

Mailing Address: __________________________________________________

City, Sate & Zip Code: _____________________________________________

Telephone #:______________________________________________________

Email: __________________________________________________________


Summer Mailing Address: __________________________________________

City, Sate & Zip Code: _____________________________________________

Telephone #:______________________________________________________

Annual Dues:

________ Individual - $15
________ Family - $20
________ Institutional - $25

Life Membership:

________ Individual under 65 - $200
________ Individual over 65 - $125
________ Couple - $200

Unrestricted Donations in Addition to Dues (Tax Deductible):
________ $15 to $49 - Trailblazer
________ $50 to $99 - Pathfinder
________ $100 or more - Voyager

Restricted Donations in Addition to Dues (Tax Deductible):
________ Lane Tavern Entrance Renovations
________ Snowroller Shed


________ TOTAL

Please make checks payable to: Sanbornton Historical Society

Mail to: Sanbornton Historical Society, PO Box 204, Attn: Membership, Sanbornton, NH 03269

e-mail: info@lanetavern.org


This document maintained Jack Potter, 603-528-1990, info@shakerwoodsfarm.com.
Shaker Woods Farm at Point Comfort, 8 March 2008