Merrimack Historical Society

Complete print out this form, complete it, and mail it with your payment to:
       Merrimack Historical Society
        P.O. Box 1525
        Merrimack, N.H. 03054

Name: ________________________________
Address: ______________________________    City/Town: _________________________________
State and ZIP Code: _____________________ Email address: _________________________
Phone Number: __________________  (please provide so we may contact you if we have questions)

Single Membership $15.00 / year Subtotal
Family Membership (2 persons from same household)
$25.00 / year  
Student & Senior Memberships (Seniors are 60 years or older) $10.00 / year  
Life Membership $100 for 60+ | $150 under age 60  
BUSINESS Membership $50.00 / year  

Enclosed is my check/money order for __________.

If you wish to make a gift of membership, simply add a note on this form who is the recipient, and how to contact them.