LANSINGBURGH HISTORICAL SOCIETY
MEMBERSHIP APPLICATION
Name____________________________________
Address___________________________________
City_________________ State____ Zipcode_______
email address________________________________
____Regular membership ($5.00)
____Sustaining ($25.00)
____Life (minimum $100)
Donation amount________
Total enclosed___________
MAIL TO: Lansingburgh Historical Society
P.O. Box 219, Lansingburgh Station
Troy, New York 12182-0219