To submit your GHS Membership Application by mail and pay by check ...

1. Print this page (or CLICK HERE for a PDF form)
2. Complete the form
3. Mail this form and your check to:
   
   Glocester Heritage Society
   Member Services
   PO Box 269
   Chepachet, RI 02814

Please make your tax deductible check payable to "Glocester Heritage Society."

Type of Membership Desired:
 Single: $15 (annual dues)
 Family: $25 (annual dues)
 Senior: $10 (annual dues)
 Student: $10 (annual dues)
 Contributing: $50 (annual dues)
 Sustaining: $75 (annual dues)
 Patron: $100 (annual dues)
 Benefactor: $250 (annual dues)
 Life: $300

Name: 
            (please include spouse's name if joining as a family)
Street:

City, State, Zip:

Telephone:

E-Mail:
              (will be kept confidential)