I (we) would like to join Falmouth Historical Society.

                ____ Individual $35                                ____ Sustaining $60

                ____ Family $40                                     ____ Patron $120

                                              ____ Life $1000

Name(s)___________________________________________________

Primary address_____________________________________________

City__________________________ State_____ ZIP________________

Telephone__________________________ Email___________________

Secondary address____________________________________________

City__________________________ State_____ ZIP________________

Effective dates_______________________________________________

____ Enclosed is a check, payable to Falmouth Historical Society.

____ Please charge ___VISA     ___MasterCard    ___Discover

Card Number____________________________     Expires________

Signature________________________________________________