Membership Information __Individual $25__Family $35
__Professional/Business $35
__Contributor $50
Name: _______________________________________________________
Street: ______________________________________________________
City: ________________________________________________________
State & Zip: __________________________________________________
Telephone: ___________________________________________________
Interests __Auction
__Barn Sale
__Buildings/Grounds __Consignment Shop
__Educational Programs __Exhibits
__Gardens
__Historical Research
__Hospitality
__Museum Guides
__Leading Walking Tours
__Photography
__Programs
__Publicity
__Restoration
__Telephone
Send form & payment to:
Historical Society of Greater Port Jefferson, Inc.
115 Prospect Street
P.O. Box 586
Port Jefferson, NY 11777
(631) 473-2665