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2. Membership*
   -- Select One --Family Membership - $20Individual Membership - $15Senior Membership - $10
4. First Name*
5. Last Name*
7. Address*
9. City*
10. State*
11. Zip Code*
13. Phone Number*
15. Email Address*

17. Please make checks payable to Guilderland Historical Society and mail to:

    Guilderland Historical Society

    PO Box 282 

    Guilderland Center, NY 12085

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19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

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