Membership Application Form

Helping to Protect Queens County's Heritage Resources

You can fill out this form online and then print it off.

Name Affiliation (if applicable) Email Address
Street, City
Province
Postal Code   Telephone Number

Membership type:
Individual ($20)
Family ($30)
Student ($10)


Please mail this form, along with remittance, to:

Mersey Heritage Society
Box 814Liverpool, N.S.
B0T 1K0
E: merseyhersoc@netscape.net

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