Instructions:
Simply print and fill out this form, and send with your check or credit card information to the address below.

Please check one:    ___This is a NEW Membership     ___This is a Membership RENEWAL

Name___________________________________________________________________

Street address___________________________________________________________

City____________________________________________ State___________________

Zip Code_______________Zip+4______________ (check magazine subscription labels)

Phone number __________________________________________________________

Email address___________________________________________________________

Please indicate desired level of membership:

_____	Individual	$40		_____	Family	$45		_____	Supporter	$75
_____	Patron	$150		_____	James Hamilton	$500		_____	Heritage Circle	$1000

____Check made payable to CCHS  ____Visa  ____Mastercard

Card #__________________________________________________________________

3-digit security code on back of card_________ Card expiration date________________

Cardholder signature_______________________________________________________

Founded in 1874, the purpose of the Cumberland County Historical Society is to collect, preserve, interpret and promote research of the history of Cumberland County. A copy of the official registration and financial information may be obtained from the Pennsylvania Department of State by calling toll-free within PA, 1-800-732-0999. Registration does not imply endorsement.