Hershey - Derry Township Historical Society

ONLINE MEMBERSHIP APPLICATION

Complete, print and mail this Membership Application to:

Hershey - Derry Township Historical Society

40 Northeast Drive, Hershey PA 17033

(717) 520-0748

Name
Address
City
State
Zip
Telephone
Email
New Member?	Yes No
If renewal, is this a change of address?	Yes No
Member Category (Check only one)	Single $20 Family $30 Business $45	Patron* $100 - $299 Founder* $300 - $499 Benefactor* $500 +
The above is a gift membership from
Please accept my additional donation of $ to benefit the following: Building FundMuseumLibrary FundPhoto Memories Berst Cemetery FundSafe Restoration FundTrolley
Membership Amount: $ Additional Donation: $ Total Enclosed: $
Please make checks payable to:►Hershey - Derry Township Historical Society The Hershey - Derry Township Historical Society is a non-profit 501(c) 3 organization dedicated to the preservation, restoration and appreciation of history of Hershey and Derry Township. We are a self-supporting volunteer organization. *Patron, Founder and Benefactor membership categories are eligible for a 10% discount at our Museum Store DIRECTIONS: Complete this form by typing in the required information, check the appropriate check boxes and print this form. Mail it to the address above.