GREATER DOVER HISTORICAL SOCIETY, INC.

(please print clearly)

____ New

____ Renewal

Member Number: _____________ Date: ________________________

Name(s) of each member: __________________________________________________

________________________________________________________________________

Address: ________________________________________________________________

City, State, Zip ___________________________________________________________

Phone: __________________________________________________________________

E-Mail Address: _______________________________Amount Paid: ________________

Individual - over 18 years old $10.00

Student $ 5.00

Family - includes children under 18 $25.00

Make all checks payable: GDHS, Inc.

Mail to: Bill Coleman, Treasurer, 3083 Jodi Lane, Dover PA 17315

E-mail address: doverhistory@gdhspa.org

Dues that are remitted before September 1 will be applied to present year. Dues remitted after September 1 will be for the upcoming year. Unless individual is a member for present year, one cannot volunteer for projects until January 1 of the following year.

The official registration and financial information of the Greater Dover Historical Society, Inc. may be obtained from the Pennsylvania Department of State by calling toll-free, within Pennsylvania, 1-800-732-0999. Registration does not imply endorsement.