Registration & Donation form

Membership Registration/Renewal

We only request information needed to conduct GTHS business. No information is shared with any other organization.
Membership Type
Membership type?*

Single ($20)Family (share same address) ($25)
Is this a new or renewal membership?*

Newrenewal
Contact Details
Name*

First NameLast Name
Second family member?

First NameLast Name
Address

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry
Email
example@example.com
Phone Number
Please enter a valid phone number.
Volunteer Opportunities
Your Historical Society exists only by the ongoing support of our volunteers. We ask you to consider offering your service in one of the following area:

Speaker program committeePublications CommitteeArchives CommitteeBoard memberOutreach committeeOther
Permission (required by privacy & anti-spam regulations)
I give the Goulbourn Township Historical Society permission to contact me via email/telephone*

YesNo
The GTHS Newsletter is published quarterly. How do you want it delivered?*

Emailregular mail
Annual Membership Fees (due January 31st) and Donations
Membership Fee*
(Individual $20 / Family $25)
Do you wish to make an Optional Charitable Donation to the GTHS?
(Receipts for tax purposes will be mailed to you shortly after your application is received and processed.)
TOTAL payment
Payment Method*

Interac e-transferchequecash
If you selected e-transfer the payee is "Goulbourn Historical Society" through your online banking service and payment is to treasurer@goulbournhistoricalsociety.org.
Make cheque payable to Goulbourn Historical Society - Please mail your payment to: Membership, Goulbourn Township Historical Society, PO Box 621, Stittsville, ON K2S 1A7
Please make cash payment to the treasurer at our next monthly meeting.
Should be Empty:

Membership Registration/Renewal