Welcome to the Clinton Historical Society, Clinton, Connecticut, U.S.A.


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To become a member or make a donation, please complete the following and mail this form with payment to: The Clinton Historical Society Membership Chairperson P.O. Box 86 Clinton, CT 06413 Name ____________________________________ (please print) Address __________________________________ City_________________State_____ Zip_________ Tel.________________Email __________________ Please check the appropriate membership category below and make a check payable to the Clinton Historical Society. ___ Individual $ 15.00 ___ Business $ 50.00 ___ Family $ 25.00 ___ Patron $ 100.00 ___ Contributing $ 35.00 ___ Lifetime $ 500.00 I wish to make a donation of $______________________
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Clinton Historical Society, 103 East Main Street, P.O. Box 86, Clinton, Connecticut 06413 copyright 2006 Clinton Historical Society ~ website design by Lisa Gugliotti, to fulfill requirement ILS 655-S70,Southern Connecticut State University, Spring, 2006

To become a member or make a donation, please complete the following and mail this form with payment to:

The Clinton Historical Society
Membership Chairperson
P.O. Box 86
Clinton, CT 06413

Name ____________________________________
(please print)

Address __________________________________

City_________________State_____ Zip_________

Tel.________________Email __________________

Please check the appropriate membership category below and make a check payable to the Clinton Historical Society.

___ Individual $ 15.00
___ Business $ 50.00
___ Family $ 25.00
___ Patron $ 100.00
___ Contributing $ 35.00
___ Lifetime $ 500.00

I wish to make a donation of $______________________