Historic Somerville

Name: ______________________________________________________

Address: _____________________________________________________

_____________________________________________ Zip Code: _______ 

Email address: _________________________________________________

Phone(s): _____________________________________________________

Number of Memberships and Type:

Amount Donated:

____Check here if you wish to receive information by mail, otherwise you will receive notices electronically. 

____Check here if you wish to opt out of announcement of business meetings, but still wish to receive notification of events.

___Check here if you are making a charitable donation and do not wish to receive the benefits of membership.

To join by mail, please print this form and fill out the information requested. Send it along with your dues (made out to Historic Somerville) to:

Dyan Blewett                               

Historic Somerville Treasurer           

48 Tennyson St.                 

Somerville, MA 02145