Membership Renewal or Application

NAME______________________________________________________

ADDRESS____________________________________________________

PHONE______________________________________________________

SPECIAL INTERESTS____________________________________________

ABLE TO PARTICIPATE AS AN ACTIVE MEMBER______________________

Renewal / Individual:  $15_____

New Member / Individual:  $15_____

Life Membership / Individual:  $100_____

Please print, fill out, and mail along with your check to:  Membership Chairperson, Squan Village Historical Society, PO Box 262, Manasquan, New Jersey  08736                     

Thank you!

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