Existing Member Short-Form Renewal or Gift Please let us know your name. Current members need only provide any information that is an update for change of what we have on file. If paying by credit card you will need to fill in billing address. Thank you! NameFirstLastMailing Address ~ Billing Address if Using Credit CardAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeYour complimentary DCHS Yearbook (generally published in December) will be mailed to this address unless indicated otherwise in comments box below.EmailPlease indicate your general preference for communicationEmailTraditional Postal MailIndicate if you'd like to receive a printed membership cardPlease mail printed Membership CardPreferred Telephone NumberChoose Your Membership LevelIndividual $35Associate $20 (only for paid members of local DC historical societies)Family $50Sustaining $100Patron $250Sponsor $500Millennial $1000No formal membership, I will make a donation, however, just belowAdditional DonationTotal$ 0.00Please indicate how you will payBy Check ~ Payable and mailed to DCHS ~ PO BOX 88 ~ Poughkeepsie NY 12602By Credit Card ~ I will fill out details belowIndicate type of Credit CardVisaMastercardAmerican ExpressDiscoverCredit CardCard NumberSecurity CodeName on CardExpirationMM123456789101112/YY1920212223242526272829If you have chosen Associate Membership, please indicate which local historical society you are a member:Your comments, interests, preferences, if you wish to state any at this time:Your complimentary, year-end DCHS Yearbook will be mailed to this address you indicated at the top of this form -- unless indicated otherwise in this comments box.PhoneSubmit Share this:TwitterFacebookLike this:Like Loading...
