Enfield Shaker Museum - Member Registration

Membership Registration

Print this membership registration form and mail it (via US Mail) to the Museum with your check or charge card information to become a member today. (Please print clearly).

Name:

________________________________________________________

Address 1:

________________________________________________________

Address 2:

________________________________________________________

City, State, Zip:

________________________________________________________

Phone:

________________________________________________________

E-mail:

________________________________________________________

Level:

___	$30 - 39	Individual
___	$40 - 99	Dual/Family
___	$100 - 249	Sponsor
___	$250 - 499	* Steward
___	$500 - 999	* Patron
___	$1,000+	* Chosen Vale Society

* Members at $250 and above receive a
beautiful reproduction oval Shaker box

[  ] Enclosed is my/our check (payable to the Enfield Shaker Museum) for: $ ___________

[  ] Please bill my Visa or Mastercard in the amount of $_____________

        Card Number ___________________________________ Expiration Date ________

        Signature (for charge card only) __________________________________________

Remit to:
The Enfield Shaker Museum
447 NH RT 4A
Enfield, NH 03748