Madison Historical Society
New Jersey 07940
Membership Form
The MADISON HISTORICAL SOCIETY
June 1, 2009 – May 31, 2010
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