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Membership Application

 The Brookfield Museum and Historical Society

PO Box 5231

Brookfield, CT  06804

 

 

I wish to join the Brookfield Museum and Historical Society as:

 

 

An individual ____ , Family ____ , Sustaining ____ , Supporting ____ , Sponsor _____ ,

 

 

Benefactor ____ ,  Life ____  member.

 

 

Enclosed is my check for $____________

 

 

Name______________________________________________________________

 

 

I wish to remain anonymous _____

 

 

Address____________________________________________________________

 

 

___________________________________________________________________

 

 

City_______________________________________State_____Zip_____________

 

 

Phone___________________________

 

 

Best time to call:    _____AM    _____PM    _____Evening

 

  

 

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