Adams Historical Society

Gift Shop Order Form

 

Item
Quantity
Size
Price Each
Subtotal

Historical Society T-shirt (S-M-L-XL-XXL)

   
$10.00
 

In This Valley by Eugene Michalenko

   
$5.00
 

Set of 4 Notecards with Envelopes

   
$3.00
 

Boys of Bob's Hill by Charles Pierce Burton

   
$9.00
 

Shipping & Handling on above items only

   
Shipping & Handling
$3.00

Gift Membership to the Society (student)

   
$3.00
 

Gift Membership to the Society (individual)

   
$5.00
 

Gift Membership to the Society (family)

   
$10.00
 

Gift Membership to the Society (contributing)

   
$25.00
 

Gift Membership to the Society (supporting)

   
$50.00
 

Gift Membership to the Society (patron)

   
$100.00
 

Contribution to the Society (tax deductible)

   
$ ______
 
         
     
TOTAL
 

Name

 

Address

 

City

 

ZIP

 

SHIP TO: (if different than above)

Name

 

Address

 

City

 

ZIP

 

SPECIAL INSTRUCTIONS:

 

 

Please print this form and mail along with check or money order payable to Adams Historical Society to:

Adams Historical Society, Park Street, Adams, MA 01220