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Membership Application:

Date: ______________    Membership level:    Student $2.00      Individual  $10.00      Family  $15.00      Sponsor  $25.00      Patron  $50.00

                                                                                   (Please  circle  membership  level)

Name ________________________________________________________________________________

Address_______________________________________________________________________________

Email address____________________________________________________________________

                                                    Make checks payable to: Walpole Historical Society, Inc.

                                                               Mail to: P.O. Box 100, Walpole, MA 02081