Membership Form

I am (Please circle one) a new member or updating my membership. TODAYS DATE: __________________ NAME: _____________________________________________________ ADDRESS: __________________________________________________ TELEPHONE: ______________________________ EMAIL: ____________________________________ I AM ENROLLING AS: (Please Circle One) $5.00 -   Child (infant-18) $7.00 -   Senior Citizen/Student $10.00 -   Individual         $15.00 -   Family $25.00 -   Contributor        $50.00 -   Donor $100.00 -   Patron            $100.00+ -   Sponsor

Please send the form and make your check payable to "Barker Historical Museum": Barker Historical Museum 7 Day Street Fredonia, New York 14063 Any questions ?  Please feel free to contact us. (716) 672-2144