Application

 

Name _______________________________

Address
______________________________________________
______________________________________________
______________________________________________

Membership Level

Basic Level

   
__ Student ($15) __ Individual ($40) __ Family ($75)

Contributing Level

   
__ Sustaining ($100)

__ Patron ($200) __ Friend ($300)
__ Francis E Spinner Club ($500) __ General Herkimer Club ($1000)  

Payment method

Please mail to: Herkimer County Historical Society, 400 N. Main St., Herkimer, NY 13350