Preservation Howard County Membership Form


	Preservation Howard County
	A countywide historic preservation organization

Join Preservation Howard County
To join PHC, please print this form and mail it to the address below.

Preservation Howard County
Membership Form

Benefactor $500
Supporter $250
Sponsor $100
Patron $50
Corporation $100

Individual $25
Student $20
Senior $20
Family $35
Organization $35

Name:*

___________________________________
*as you wish to be acknowledged

Address:

___________________________________

City:

___________________________________

State:

_____ Zip: __________

E-mail:

___________________________________

Phone:

___________________________________

Mail this form with your check payable to Preservation Howard County to:

Preservation Howard County
P.O Box 6512
Ellicott City, MD 21042-6512