Membership form

Historical Society for the Preservation of the Underground Railroad
PO Box 8436
Albany. NY 12208
518-458-7888 
1-888-994-SPUR (1-888-994-7787)
ugrr_spur@yahoo.com

Membership type	Yearly fee
General Member	$30.00
Family Member	$30.00
Institutional Member	$100.00
Contributing Member	$200.00
Sustaining Member	$250.00
Sustaining Member	$500.00
Student Member, Senior Citizens	$20.00
	Subtotal:_________ Total:_________

Name: _____________________________________________

Address: ___________________________________________
               ___________________________________________
               ___________________________________________

Phone: __________________

Method of Payment

Check
Bill Me
Visa
MasterCard
American Express

 _______________________     ___/___
Credit Card #                                    Exp. date

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Signature

Historical Society for the Preservation of the Underground Railroad is a not-for-profit 501(C)(3) corporation with the sole mission of preserving the history of the Underground Railroad.