(413) 323-6573 · www.stonehousemuseum.org

MEMBERSHIP FORM -- May 1, 2008 thru April 30, 2009

The Belchertown Historical Association, a non-profit organization, exists primarily on income from your membership, event admissions, contributions and bequests.

A membership entitles you to

· Unlimited visits to the Stone House Museum complex (excluding special events) during the membership year, May 1, 2008 thru April 30, 2009

· Subscription to the Association Newsletter

· Discounted admission to museum events and special member privileges when announced

While these are significant benefits, the real benefit is the sense of belonging to an organization which is preserving our past for our future.

Membership benefits subject to change.

We no longer issue membership cards. A complete list of members is kept at the museum entrance at all museum events.

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Yes! I am pleased to support the Belchertown Historical Association and want to renew/join.

NAME: ________________________________________________________________________

ADDRESS: ________________________________________________________________________

TELEPHONE (optional):__________________________ EMAIL (optional):_______________________

If a Gift Membership, please indicate whom the gift is from: ___________________________________

Please indicate category of membership and return the completed form with your tax deductible check payable to Belchertown Historical Association to BHA at the address above. Please consider moving up a level! Thank you very much for your continued support.

____Individual: $15 per person	____Family: $30 per family (children under 18)
____Student (under 18): $5 per person	____Friend: $50
____Senior (65+): $8 per person	____Patron: $100
	____Benefactors: $250

____Additional Membership Donation $_________

____Membership Donation in Honor or Memory of: _______________________________

____Corporate Matching Program: Attached is my employer’s corporate matching gift form

Would you like to be involved in activities of the Association? If so, please indicate your interests and skills, and the best time for us to contact you.

Please consider including the Belchertown Historical Association in your estate plans.