NAME:    ____________________________________________________________

ADDRESS:___________________________________________________________

                    ___________________________________________________________

PHONE: ________________________(Day) ________________________(Evening)

E-MAIL: ______________________________________

DATE: ________________________________________

Mail to: New Hampshire Archeological Society
                 Attn: Treasurer
                 P.O. Box 406
                 Concord, NH 03302-0406

Include check made out to the New Hampshire Archeological Society or NHAS for the amount corresponding to the type of membership you'd like:

                                    ______ Individual ($25)

                                    ______ Institution ($35)

                                    ______ Senior or student ($18, photocopy of valid student ID         
                                                   required)

                                    ______ Lifetime membership ($425)