Montgomery County Historical Society
Membership Application
Name:___________________________________________________________
Address:______________________________________________________
_________________________________________________________________
Phone:________________
E-mail:__________________________________________________________
Would you like to be notified by e-mail of upcoming events?________
Please Check Membership Level:
_____Basic $35_____Check here for Genealogy Club (no additional cost)
_____Century Circle $100_____Heritage Circle $250
Method of Payment:
_____A check made payable to MCHS is enclosed
Please charge my credit card:______Visa______Mastercard______Discover
________Amex
Account#:________________________________________
Expiration:________________________
Signature:________________________________________
MAIL TO: MCHS, 111 W. MONTGOMERY AVENUE, ROCKVILLE, MD 20850
To charge by phone call: (301)-340-2825
The Montgomery County Historical Society is a 501(c)(3) nonprofit organization- dontaions to which are tax deductible to the fullest extent allowed by law. A copy of our current financial statement is available upon request by contacting MCHS at 111 W. Montgomery Avenue, Rockville,MD, 20850; phone 301-340-2825. Documents and information submitted to the State of Maryland under the Maryland Charitable Solicitations Act are available from the Office of the Secretary of State for the cost of copying and postage.