The League of Historical Societies of New Jersey

APPLICATION FOR MEMBERSHIP

Please provide all of the information in full. In the “Mailing” spaces, please write “YES” or “NO”

so that we know which people in your society should receive the League News and other mailings.

Name of Organization ________________________________________________________________

Address ___________________________________________________________________________

City ___________________________ State, Zip________________ Phone _____________________

Fax _________________________ Email address _________________________________________

Organization Website ________________________________________________________________

Number of members _________ County______________________ Receive mailings?________

President’s name ____________________________________________________________________

Address ___________________________________________________________________________

City ___________________________ State, Zip________________ Phone _____________________

Email address _________________________________________ Receive mailings?________

Delegate name ______________________________________________________________________

Address ___________________________________________________________________________

City ___________________________ State, Zip________________ Phone _____________________

Email address _________________________________________ Receive mailings?________

Alternate Delegate name ______________________________________________________________

Address ___________________________________________________________________________

City ___________________________ State, Zip________________ Phone _____________________

Email address _________________________________________ Receive mailings?________

Date _______________________ Signature _____________________________________________

League membership dues are $30 per year (November 1 to October 31). Please make your check payable to the League of Historical Societies of New Jersey (LHSNJ) and mail to:

LHSNJ, c/o D.E. Pietrowski, P.O. Box 909, Madison, New Jersey 07940

APPLICATION FOR MEMBERSHIP