MANCHESTER HISTORIC ASSOCIATION MEMBERSHIP FORM

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I/We would like to join the Manchester Historic Association in the following category:

F.P. Carpenter Circle ($1,000)	Family/Dual ($60)
Sponsor ($500)	Senior Dual ($50)
Benefactor ($250)	Student/Teacher/Senior ($25)
Patron ($125)	Individual ($30)

Corporate Membership Categories:

President's Circle ($1,000)

Amherst ($500)

Millyard ($250)

Name:
Address:
City:		State:		Zip:
Phone:
E-Mail:
Comments:

129 Amherst Street
Manchester, NH 03101
Phone:	603-622-7531
Fax:	603-641-8191