Walpole Historical Society Membership Form

Name:

Address:



City, State, Zip:        ,

Select One:              Single ($20.00)                                 Patron ($50.00)
                                           Family ($35.00)                                 Sustaining ($250.00)

Complete the form and print it - Questions to the Secretary
Please make check payable to Walpole Historical Society, and mail to:
PO Box 292, Walpole, NH 03608