PAXTANG
HISTORICAL SOCIETY
MEMBERSHIP
APPLICATION
Complete and mail this Membership Application to:
Paxtang Historical Society
3423 Derry Street
Harrisburg, PA 17111
The purpose of the Paxtang Historical Society is to preserve the history of Paxtang Borough for future generations through collecting, storing, and preserving artifacts and oral history; providing educational opportunities; and promoting historical advocacy.
Date ____________________
Name ___________________________________________
Address ___________________________________________
___________________________________________
City State Zip
Telephone (_____)___________________________
E-mail _______________________________________
Membership
Fees are on an annual basis from the time of application except for the
Lifetime Membership.
O Individual (annual) $5.00
O Family (annual) $10.00
O Lifetime Member $50.00
O Additional Donation $____________
Please make checks payable to “Paxtang Historical Society”
Form # PHS-101 (23 May 2005)
PAXTANG HISTORICAL SOCIETY
Interest Form
(please print)
First
Name_________________________________________
Telephone
# __________________________
E-mail
address______________________________________
Any
previous experience with a project of this nature? (circle) YES
NO
I
have documents, articles, that I am willing to donate. (circle) YES NO
I
have photos that I am willing to donate.
(circle) YES NO
I
have memories that I am willing to share. (circle) YES NO
I
am willing to assist (circle): oral interviews transcribing
video-taping conservation research Board of
Directors
grant writing
deed searches (building history)
deliver flyers
news letters
other (please list)
_____________________________________________________________
_____________________________________________________________
__________________________________________________________________________________________________________
Form # PHS-105 (09 Sep 02)