Membership Application, Surry County, Virginia, Historical Society and Museums, Inc. Surry County Virginia Historical Society and Museums, Inc.
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Surry County, Virginia, Historical Society and Museums, Inc.
P. O. Box 262, Surry, VA 23883   Phone (757) 294-0404
E-mail address: [email protected].
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Surry County, Virginia, Historical Society and Museums, Inc.

MEMBERSHIP APPLICATION

Name __________________________________ Please Check below
Address ________________________________ New Member? _____________
State & Zip Code _________________________ Renewal? ___________________
Phone Number ___________________________ Membership Class _________________________
E-mail address____________________________ Date _______________________
Choose one of the following classes of membership. Amount Paid $__________________
Class of Membership Annual Dues
Member $20.00
Sustaining Member $50.00
Benefactor Member $100.00
Life Member $500.00
Student Member $5.00

Please make checks payable to: Surry County, Virginia, Historical Society

and mail to P. 0. Box 262, Surry, Virginia 23883.

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We are also happy to receive your application written by hand on a piece of paper!

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