West Hants Historical Society

Membership Application
Is this a New or Renewing Membership

NewRenewal
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number
Please enter a valid phone number.
Yearly Membership Type:*

Individual Membership ($20)Family Membership ($30)Institution Membership ($50)
Would you like to volunteer?

Research & GenealogyArchives & MuseumBuilding & MaintenancePublic Relations and/or Social MediaOther
Payment Information:
Payment Method*

Credit CardE-TransferCash/Cheque

My Products

Individual Membership

Yearly Individual Membership

$20.00CAD for each year

Family Membership

Yearly Family Membership

$30.00CAD for each year

Institution Membership

Yearly Business, Institution, Organization Membership

$50.00CAD for each year

Additional Information:
How did you hear about us?
Why are you interested in joining our association?
Do you have any special skills or interests you would like to contribute as a member?
Any other comments or questions?
Declaration:

I certify that all information provided in this application is true and accurate to the best of my knowledge. I understand that membership approval is at the discretion of the association and may be subject to review.
Please verify that you are human*
Date

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Date
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Membership Application