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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?
One Time
Yearly
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
*
Verify Email
*
Phone
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
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
Add 3% to my total amount to help cover the payment processing fees