FRENCH CABLE STATION MUSEUM MEMBERSHIP

Name _________________________________
Address _______________________________
Address _______________________________
Email _________________________________

Type of membership

O	Life	$500.00	O	Supporting	$100.00
O	Contributing	$30.00	O	Individual	$10.00

Date…………………… Amount Enclosed………………

Mail form and check to
French Cable Station Museum
PO Box 85
Orleans , MA 02653