drugs and their effects

Membership/Donation Form

image_pdfimage_print

Please complete and print this form using the above printer icon button. 

Send with your payment to:

Yorktown Historical Society

 P. O. Box 355

Yorktown, NY 10598

           Membership Catagories  

  Individual Membership        $20.00 USD
  Student          $10.00 USD
  Senior              $15.00 USD
  Senior Family        $25.00 USD
  Family        $30.00 USD
  Sustainiing        $50.00 USD
  Sponsor/Institutional      $100.00 USD
  Patron      $250.00 USD
  Benefactor      $400.00 USD
  Life Member      $500.00 USD

Cash Donation        $  

Total Payment        $  

Name 

Address 

Phone  

Email 

Please make all checks payable to Yorktown Historical Society.  

If you prefer to pay via a PayPal account or credit card, go here and use the Donate button. Be sure to enter the correct total payment amount on the PayPal/credit card page and indicate method of payment below.

  PayPal payment

  Credit card payment

 

 Copyright © 2007 – 2016 | All Rights Reserved

Contact the Webmaster regarding any problems with this page.