Hancock House - Membership Form in HTML

The Ticonderoga Historical Society has new and exciting activities
planned for this year, and we would like to invite you to join us!

Please fill out the form below to let us know how you would
like to help the Society, and send it to the following address:

Ticonderoga Historical Society
Hancock House
6 Moses Circle
Ticonderoga, NY 12883

I would like to become a member of the Ticonderoga Historical Society.
My membership check is enclosed in the amount of:

Annual:	___ Individual ($15.00)	or Lifetime Membership:
	___ Student ($10.00)		___ ($250.00)
	___ Family ($45.00)
	___ Business ($75.00)

My payment is enclosed:

___ Check or Money Order

___ Credit Card: ___ Visa ___ MasterCard

Number: ___________________________________ Expiration Date: ___/___

___ I am interested in becoming a volunteer:

My area of interest is ______________________________________________
______________________________________________

___ I would like to donate ___ money ___ items to the Historical Society.

Name: _____________________________________________________
Address: ___________________________________________________
City: _____________________________ State: ________ Zip: _________
Telephone: ( ) __________________ Email: ____________________

Members receive a 20% discount on many items in our Post Office Gift Shop.

___ Check or Money Order
___ Credit Card:	___ Visa	___ MasterCard
Number: ___________________________________ Expiration Date: ___/___