Nanticoke Valley Historical Society
2008 Membership/Donation Form
I wish to be a member of the Nanticoke Valley Historical Society ____ I wish to make a donation to the Nanticoke Valley Historical Society ____ Individual $15 ___ Family $20___ Patron $25____ Business $100.00 ____ My employer provides a matching grant ____I wish to make a tax deductible donation of $___________ ____This is a gift membership for ____________________________________ Name____________________________________Phone________________ Address__________________________________City__________________ State__________Zip_____________E-mail___________________________ | 