Pejepscot History Center · PHC Membership Form

Amount *

$1,000 - 1888 Guild

$500 - Pejepscot Proprietors

$250 - Community Caretakers

$100 - History Heroes

$60 - History Lovers - Family

$40 - History Lovers - Individual

$20 - Active Student (subject to verification)*

One Time or Annual Recurring?

Continue donating until

(mm/dd/yyyy)

Contact Information

Name *

First Name

Last Name

Name of Second Family Member

First Name

Last Name

School, University, or Institution currently enrolled at:

*Please complete this field to register for the Active Student Membership Level

Email *

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Phone

Address *

Address Line 1

Address Line 2

City

State/Province

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Anything you'd like to add?

Other (please specify):

How did you hear about us?

Word of Mouth

Social Media

Took a tour

Attended an Event or Program

Maine Public Radio

Downeast Magazine