Membership Application Form

Charleswood Historical Society Membership Application

To apply for membership please complete all questions.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
E-mail
Home Number*

Area CodePhone Number
Cellular Number

Area CodePhone Number
Work Number

Area CodePhone 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