Port Norris Historical Society Membership Application Form

New Renewing Individual Family Benefactor Student

Name _______________________________________________________________________________

Mailing Address ______________________________________________________________________________________

City _______________________________________________________ State _____________ Zip _____

E-mail ________________________________________

Home Phone _________________________

Individual - $20

Family - $30

Benefactor - $50 and over

Student - $5 (not voting privileges)

Complete this order form and return it with your payment to: Port Norris Historical Society, PO Box 187, Port Norris, NJ 08349