Membership Application

 

Membership Levels

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Student/Senior Citizen: $20.00

Individual: $30.00

Family: $40.00

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Supporter Levels:

Silver: $50.00

Gold: $75.00

Diamond: $100.00

Patron: $200.00

Benefactor: $500.00

 

[ ] Yes, I would like to become a member of the Wallace House and Old Dutch Parsonage Association:

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NAME:______________________________________________________________________________________

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STREET ADDRESS:________________________________________________________________________________

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CITY:_______________________________________________STATE:_____________________________ZIP:_______

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EMAIL:___________________________________________________________________________________________

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My $________check for membership is enclosed. (Membership received after July 4th of a year will be credited to the end of the following calendar year.)

 

[   ] I am contributing an additional $__________to support the work of the Wallace House and Old Dutch Parsonage Association in preserving the continuing message of these special sites.

 

Thank you for your generosity.

 

Please print this form, fill it in, and mail it with your membership dues (and any additional contribution) to our mailing address: 

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The Wallace House and Old Dutch Parsonage AssociationP.O. Box 225, Somerville, New Jersey 08876

 

 

The Association is a Federal 501(c)(3) corporation and your contribution is tax deductible to the fullest extent permitted under the law.