PITTSTOWN HISTORICAL SOCIETY

Membership application/renewal form
(print & mail to the address below)

	$10 Individual		$5 Senior (65 & older)
	$25 Supporter		$50 Benefactor
	$15 Business

	Total (enclose check for this amount)
	I would like to volunteer my time

  Name:

  Address:

  City, State, Zip:

  Telephone Number:

  E-mail address:

Make checks payable to:  

Pittstown Historical Society

P.O. Box 252, Valley Falls, NY 12185