
Membership
YOU ARE IN : home » Membership
Membership Form
Join the Yaphank Historical Society by paying dues for the current year. If you are interested, please complete and send in the form to:
Yaphank Historical Society
PO Box 111
Yaphank, NY 11980-0111
Please enroll me as:
(_) Active Member | $20.00/person - $17.50/Senior Citizen (62+) $25.00/couple - $22.50/Senior Couple (62+) |
(_) Contributing Member | $50.00 |
(_) Life Member | $100.00/person - $75.00/Senior (62+) |
(_) Patron Member | $300.00 |
(_) Benefactor Member | $500.00 |
Name___________________________ Telephone #_______________
Address_________________________ E-Mail:____________________
Town___________________________State_______Zip Code________