Text Box: The Millbrook Society Membership Application Form Name: ___________________________________________________If student, grade: _____ Street Address: _______________________________________________________________ City: _____________________________ State: __________ Zip Code: __________________ Telephone: ( ) E-mail: ________________________________ Special Talents: ___________________________________________________________________________ Interests: (Please check any of the following that apply. Passive membership is acceptable.) ( ) Archaeology ( ) Article Writing ( ) Field Trips ( ) Fundraising ( ) Genealogy ( ) Library ( ) Local History ( ) Museum ( ) Presentations ( ) Publicity ( ) Re-enacting ( ) Research ( ) Society Special Event Support ( ) Society News Reporting ( ) Student Intern Program ( ) Web Site Support Membership Types: (Please check one of the following 1-year memberships or Life membership.) ( ) $500 Corporate Sponsor ( ) $200 Fellowship ( ) $150 Booster ( ) $50 Patron ( ) $25 Family ( ) $18 Individual ( ) $12 Student / Senior Citizen ( ) $1000 Life membership Please return the completed application with your check or money order made payable to: The Millbrook Society P.O. Box 506 Hatboro, PA 19040