Membership Application Form

Charleswood Historical Society Membership Application

To apply for membership please complete all questions.
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City

Zip Code
E-mail
Home Number *

Area Code Phone Number
Cellular Number

Area Code Phone Number
Work Number

Area Code Phone Number
Maiden Name (if applicable)
Number of Years living in Charleswood
Returning or New Member *
Membership Type *
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SINGLE 1 Year Membership $ 15.00

FAMILY 1 year Membership $ 20.00
Membership may be paid at the Charleswood Museum, 5006 Roblin Blvd., open every Saturday 2-4 PM. Complete the form and press the print button below and bring to the Charleswood Museum.
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Charleswood Historical Society Membership Application