MERRIMACK HISTORICAL SOCIETY MEMBERSHIP FORM

Name: _________________________________________________
Nickname (how your commonly called): _______________________
Address: _______________________________________________
Telephone: (Home): ______________(Work): _________________
Email Address: __________________________________________
Birth date: _______________ Spouse's Name __________________
Do you live in Merrimack? __________ How Long? _____________
Do you do family history research (genealogy)? ______
If yes, what surnames are you researching _________________
Are they connected to Merrimack? _______________________

Print and fill out the form and mail along with your dues to:

Merrimack Historical Society
Attn: Membership
520 Boston Post Rd.
Merrimack NH 03054