Membership Application

NEW MEMBERSHIPS: IF YOU ARE NOT CURRENTLY A MEMBER OF THE L-WHS

The year 2010 is the 204^th anniversary of the establishment of a community that would become present day Lilly Borough and Washington Township. The Lilly Washington Historical Society

(L-WHS) intends to recruit all current and former residents of Lilly Borough and Washington Township.  Check the form below- join the ongoing celebration!

LILLY-WASHINGTON HISTORICAL SOCIETY  -   MEMBERSHIP OPPORTUNITIES

If you wish to become a member of the L-WHS, please check off the membership you choose:

___ Heritage –No Charge -Honorary life membership for any present or former resident of Lilly

                        Borough or Washington Township who is 80 years of age or older, or who reaches

                        the age of 80 during this membership year.  _______________ BIRTHDATE

___ Adult -   Amount you wish to donate to be a Member of L-WHS ($5.00 per year minimum)

___ Life - $50.00 – Membership for the remainder of the applicant’s lifetime

___ *Life Sponsor - $100.00 – Life Membership and $50.00 donation

___ *Life Patron - $150.00 – Life Membership and $100.00 donation

___ *Life Benefactor - $250.00 – Life Membership and $200.00 donation

          * Names are listed on Bronze Plaque                   

                                                _________________________

                                                  DESIGNATION OF DONATIONS

$_______ - UNRESTRICTED TO THE L-WHS GENERAL FUND

$_______ - MEMORIAL ($25) Deceased’s Name _____________________________________

$_______ - *MEMORIAL SPONSOR ($50) Deceased’s Name ___________________________

$_______ - *MEMORIAL PATRON ($100) Deceased’s Name ___________________________

$_______ - *MEMORIAL BENEFACTOR ($200) Deceased’s Name ______________________

*Names are listed on Bronze Plaque

$_______ - MUSEUM FUND - $25 to $1000. – ($250 to $1000. Donors Name listed on Plague)

$_______ - MONUMENT FUND - $1000 to $10.000 – Donors name listed on Plaque

$_______ - OPERATIONS FUND (Furniture-Equipment-Office Supplies-Insurance) $25 to $500      

$_______ - FUND for Organizational Memberships, Consultants, Workshops, Seminars - $25 >  

                                                    _________________________        

$________Total Sum of All Memberships and Donations – Make checks payable to L-WHS

     Return Form and check to L-WHS – c/o First National Bank of Lilly – Lilly, PA 15938

                        Name                                  Street Address                                Phone #

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