You are invited to become a member of the Salem County Historical Society.

Please complete and return this form with check payable to:

Salem County Historical Society 79-83 Market Street Salem, NJ 08079

NAME(S): ______________________________________________________________

NO. & STREET : _________________________________________________________

CITY, STATE & ZIP : _____________________________________________________

TELEPHONE NO. _______________ Please check: New _______ Renewal ________

___ Individual $25.

___ Family/Household $40.

___ Student $10.

___ Benefactor Individual $250.

Corporate/Business Categories:

___ Fenwick Benefactor $1,000. +

___ Goodwin Provider $500. - $999.

___ Pedersen Provider $250. - $499.