Membership Application

Yes, I would like to begin ____ renew _____ my yearly membership with the PAC/VBHS.

  Name_____________________________________________________________________________

  Address___________________________________________________________________________

  City____________________________________________ State _________ ZipCode_____________

  Home Phone _______________________________ Office _________________________________

  Cell Phone _________________________________ Email _________________________________

  Membership Level

  ____Individual         $15.00

  ____Family              $25.00

  ____Senior               $10.00

  ____Organization     $50.00

  ____Associate        $100.00

  ____Life                 $250.00

  Additional tax-deductible donation for preservation $__________________
 

Mail Application Form and Check or Money Order in US currency only to:

PAC/VB Historical Society
c/o Membership Chairman
2040 Potters Road
Virginia Beach, VA 23454

Please Make Check or Money Order payable to "PAC/VB Historical Society"