Schoharie County Historical Society
Membership Application

Complete this form, print it out and mail it with your payment to:
        Schoharie County Historical Society
        145 Stone Fort Road
        Schoharie N.Y. 12157


Name: ________________________________

Address: ______________________________

City: _________________________________

State and ZIP Code: _____________________

Optional: Phone Number: ___________ Optional: E-mail address: ___________

Membership Categories (Annual Dues)
Individual $25 Sustaining $50
Family $40 Supporting $75
Senior Citizen $20 Benefactor $100
  Life $1,000
Membership includes a subscription to the Historical Review and other benefits.

Enclosed is my check for __________ dues and ___________ additional gift

Please charge my credit card: VISA ____ MasterCard ____

Card Number: ________  _________  _________  __________

Expiration Date: _________________

Signature: ___________________________________________

Thank You! Your support is appreciated!


I would like to volunteer for (check any which apply):