The Lower Eastern Shore Heritage Council Membership

Please print and fill out this form and send it to the address below.

Please Check One:
__ $20 Individual	__ $30 Family
__ $75 Supporting	__ $100 Patron
__ $150 Local Business	__ $500 Corporate
__ $1000 Distinguished Benefactor	__ $10 Student
Total Enclosed	$

Name:
Address:
City:
State:
Zip:
Phone: Area Code ( )
E-mail address:

Please indicate your interest in serving on a committee:
__ Membership	__ Workshop/Seminars
__ Fundraising	__ Public Relations