Membership Application    
The deadline for the MEMBERSHIP dues is July 2009.

PLEASE PRINT THIS MEMBERSHIP APPLICATION FORM AND MAIL TO ADDRESS BELOW.

A receipt will be sent ONLY if requested. ALL donations and dues are federally tax-exempt.

Please make your CHECK PAYABLE TO:

Botsford Family Historical Assn., Inc.
c/o Helen Botsford Faucher
Executive Secretary, 215 Buckingham Ave.
Milford, CT 06460


MEMBERSHIP APPLICATION FOR
BOTSFORD FAMILY HISTORICAL ASSOCIATION, INC.

Enclosed herewith is my check for$ _____________
Dated as follows:_______________
MEMBERSHIP DUES:
Household Membership
(adult couple or single person @ $10)		 $_______________
Junior Membership
(under 18 yr. old @ $2.50)		$_______________
       Name: __________________________
       Name: __________________________
       Name: __________________________
(Note: Maximum dues for family $15.00)
List your Line of Descent: _________________
**A membership card will be sent upon request**

Contributions
Help feed our site to keep us up and running

Please fill in your contribution amount below.

General Fund$________________
Genealogical Fund$________________
Other: Contact Executive Secretary at address above 



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