Return to:  CCHS
21 NORTH PITT STREET
CARLISLE PA  17013

Print and send in with check or credit card information or contact Janeal Jaroh, Education Curator, at 249-7610 or by email at edcurator@historicalsociety.com
 
Please fill out a seperate form for each child you are enrolling.

Parent Name __________________________________________________

Student Name _________________________________________________

Age and Grade _________________________________________________

Address ______________________________________________________

             ______________________________________________________

Phone ________________________________

Email Address _________________________________________________

Member of the Cumberland County Historical Society?     Yes        No      (circle one)
(Membership information by clicking here)

Check made out to CCHS is included for the amount of ______________________________________

Information for credit card charge:

Mastercard                   VISA         (circle one)

                                                                             3-digit number
Card #________________________________ on back of card______   Expiration Date____________

Signature______________________________________________