Belmont Historical Society

Join us to share, learn and preserve our special community heritage!

(You can also use this form to order the publication with or without joining.)

MEMBERSHIP / ORDER FORM

Annual membership dues:
___ Individual $10.
___ Family $15.

Publication:
___ A “Belmont NH Postcard” book at $24.99 (includes $5 shipping)

Please send checks payable to:

Belmont Historical Society
% Jane McLetchie, Treasurer
180 Dutile Road, Belmont NH 03220

Name:________________________________________________
Address:______________________________________________
City:________________________ ST:______ Zip:____________
Telephone:_____________________________________________
Email:________________________________________________
Volunteer interests:______________________________________
______________________________________________________
______________________________________________________

Thank You

TOTAL MEMBERSHIP AMOUNT $_________
ADDITIONAL DONATION $_________

A “Belmont NH Postcard” book at $24.99

$_________
TOTAL AMOUNT ENCLOSED $_________