2022 Membership Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Lake Charlotte Area Heritage Society

Membership For *

2022 Membership

Lifetime Membership

Name *

Home Address *

Province *

Primary Phone Number *

Other Phone Number

Email Address *

Membership Type *

Individual - $25

Couple - $50

Family - $55 (two adults and up to 3 children / youth)

Lifetime Individual - $225

Card Names

Please list the names for each additional card (i.e. for a couples membership you have the option for each person to have their own card)

Name for Card 1 (if different from above)

Name for Card 2 (Family)

Name for Card 3 (if applicable)

Would you like to make an additional donation to the Lake Charlotte Area Heritage Society / Memory Lane Heritage Village at this time?

Yes! I would like to make an additional donation

Not at this time

Amount of additional donation

Are you interested in becoming a volunteer?

Yes, please contact me!

Not at this time

Clear selection

Would you like to be added to our newsletter mailing list to stay in the loop with events, dinners, announcements, etc?

Yes, sign me up!

Not at this time

Clear selection

Membership Payments

Send your payment to us in one of the following ways...

- Mail a cheque made out to the Lake Charlotte Area Heritage Society to 5435 Clam Harbour Rd, Lake Charlotte NS, B0J 2L0

- Send an email money transfer to payments@visitmemorylane.ca

- Purchase through our online gift shop on our website at hoskinggeneralstore.ca

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms