Membership

Please type your information into the spaces provided,
then print and mail this form with payment to:

Chesterfield Historical Society
P.O. Box 40
Chesterfield, VA 23832

The membership year is from January 1 through December 31
Society dues are tax deductible
Part-year memberships will not be offered

Name
Street Address
City
Zip
Phone
E-mail
Type of membership desired		Student (under 18) $10 Senior Citizen (65 & older) $15 Senior Couple (65 & older) $25 Individual $20 Household $30 Benefactor $500 Corporate $1000
Amount enclosed