|( ) Senior Citizen||$15.00||( ) Historian||$100.00|
|( ) Individual||$20.00||( ) Archivist||$500.00|
|( ) Family||$30.00||( ) Benefactor||$1,000.00|
|( ) Curator||$50.00|
In addition to my membership, I'd like to contribute the amount of $______________ to the Needham Historical Society to be used for _______________________.
Dues are for the calendar year. Please indicate if this is a new _____ or a renewal _____ membership.
|City, State, Zip||_____________________________________________|
( ) Check here if your employer has a matching funds program.
Please print and mail with your check to: