Derby Historical Society

Founded April 18, 1946 to serve the Naugatuck Valley towns of Ansonia, Derby, Oxford, Seymour & Shelton

 

“Celebrating a Proud Past and a Promising Future”


 

                                    2016 Membership Application                       

                                                                       

Categories of Membership:

 

College Students or Service Members          $15 per year                                   Individual Member       $30 per year

 

Family Membership                                             $40 per year                                   Life Membership                       $250 per year

 

Name                                                                                                                                                           

 

Address                                                                                                                                           

 

E-mail (if applicable)                                                                                                                   

 

PLEASE LET US KNOW IF YOU WOULD LIKE TO VOLUNTEER TO HELP WITH    __________ SPECIAL EVENTS        __________FUNDRAISING       __________PROGRAMS

 

CONSIDER MAKING AN ADDITIONAL DONATION OF $_____________ TO BENEFIT OUR RESTORATION PROJECT OF THE GENERAL DAVID HUMPHREYS HOUSE

 (ALL DONATIONS WILL BE MATCHED UP TO $30,000 THROUGH A GENEROUS MATCHING GRANT FROM THE PERSBACKER FOUNDATION)

 

 

Please print this form and return it with your check made out to: Derby Historical Society, 37 Elm Street, Ansonia, CT  06401

 

 

*Note – If you already are a Life Member the Derby Historical Society appreciates any ongoing support you may feel is appropriate.*

 

Thank you for your support!