Photographic Historical Society of New England, Inc.
PLEASE PRINT OR TYPE
Photographic Historical Society of New England, Inc.
PLEASE PRINT OR TYPE
Enroll me as an ___ Student ($15)____ Individual ($30) _____ Family ($36) _________International ($40) member of PHSNE.(check one)
Date of application ________________
(Membership is on a calendar year basis. Those who join in September or later in the year are automatically members for the following year.)
Name ____________________________________ Street _____________________________________
City/State/Country __________________________Zip ______
Home Phone ( ___) ___-____ Business Phone ( ___) ___-____ E-mail _____________________
Photographic interests:
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
$30 Individual membership $36 Family membership $40 Foreign individual membership, $15 Student
Print this form by clicking on "print", fill it in, and mail it with a check (to PHSNE) in US funds to:
Photographic Historical Society of New England, Inc.
Adrian Levesque
Membership Chairman
4 Sugar Hill Drive,
Nashua, NH 03063
