Madison Historical Society
      New Jersey   07940
  
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Membership Form
 
The MADISON HISTORICAL SOCIETY

June 1, 2009 – May 31, 2010

Please circle membership category

 BENEFACTOR ….….…...$100
 
SUSTAINING…..…....……$75
 
FAMILY(list names below) $40
 
INDIVIDUAL….…..….…..$25
 
STUDENT (under 21)… ..…$5
 
Name _____________________________________________________________

Address_______________________________________________________

Telephone_______________________ Email__________________________

Please  print this page,  complete the information, and enclose it with 
your tax deductible check to The MADISON HISTORICAL SOCIETY at:
P. O. Box 148 , Madison, NJ 07940

 For further information, contact
The MADISON HISTORICAL SOCIETY 
973-377-0722, Ext. 8

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