Bethel Historical Membership Form

MEMBERSHIP LEVEL

I AM MAKING A DONATION OF:

$00.00

I WOULD LIKE TO VOLUNTEER FOR:

Name

PrefixFirst NameLast Name

Email

example@example.com

Phone Number

Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

NOTE: The Bethel Historical Society is a charitable organization under Section 501(C) (3) of the Internal Revenue Service
Code. Therefore, your contribution may be tax deductible. Check with your tax advisor for further details.

Bethel Historical Society, Inc. 40 Main Street, Bethel CT 06801

http://www.bethelhistoricalsociety.com

REMEMBER if you belong to a corporation or organization with a matching gift program; please submit a request form to us
for that matching gift.

Date