MEMBERSHIP REQUEST/RENEWAL

Please enroll/renew me/us as a member for _______:

Last name:_________________________  First name:_________________________

Address:______________________________________________________________

Town:__________________  Province:____________ Country:_________________

Postal Code:_________              Telephone:     (_______)_______________________

email address:__________________________________________________________

Dues for one calendar year are:    Membership ($25.00):     $______________

                         Donation to Society:          $______________

                         TOTAL enclosed:          $______________

Send to Huntley Township Historical Society, Box 313, Carp, Ontario, K0A 1L0