The Jewish Historical Society of Lower Fairfield County

Yes, I am happy to support The JHSLFC with my membership.

To contact us with your membership application, you can print and mail this form, along with your check to:

The Jewish Historical Society
of Lower Fairfield County
P. O. Box 16918 Stamford, CT 06905-8901

Fill out the information below from your keyboard, or print the form and then fill it out.
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Name (Last):
Name (First):
Telephone (include area code): Day Ext. / Evening
E-mail Address:
Street Address1:
Street Address2:
City: State: Zip Code + 4:

Annual Dues: Yearly membership dues are from August 1 to July 31 in any given year.

Enclosed is my/our contribution of
	$5	Student
	$20	Single
	$36	Household
	$100	Sustaining
	$250	Patron
	$400	Life Membership
	$100	Corporate
	Additional Donation $____________

I am willing to work on the following committee(s)
Archives	Oral History	Membership
Programming	Speakers' Bureau	Photography

for more information, please call (203) 321-1373, Extension 150 or e-mail us at jhslfc@gmail.com

Thank you!

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