Membership Sign-up Form
Name: ____________________________________________________
Address:___________________________________________________
___________________________________________________
City, State, Zip: _____________________________________________
Phone: _____________________________________________________
Email: _____________________________________________________
I was a student at the school from _________ to _________
My employer has a matching gift program (yes or no) _________
This donation is in memory of:
___________________________________________________________
Member Status:
$500 — Principal
$100 — Honor Roll
$75 — Teachers Pet
$50 — A+ Student
$25 — Scholar
$____- Preservation Award
Members receive:
- Kripplebush Schoolhouse Newsletter
- Free unlimited visits to the museum
- Voting privilege at annual meeting
Please print, mail & make your tax deductible checks payable to:
Kripplebush Schoolhouse Museum Inc.
PO Box 91
Stone Ridge, NY 12484
Your name will not be shared with other organizations.
Name: ____________________________________________________
Address:___________________________________________________
___________________________________________________
City, State, Zip: _____________________________________________
Phone: _____________________________________________________
Email: _____________________________________________________
I was a student at the school from _________ to _________
My employer has a matching gift program (yes or no) _________
This donation is in memory of:
___________________________________________________________
Member Status:
$500 — Principal
$100 — Honor Roll
$75 — Teachers Pet
$50 — A+ Student
$25 — Scholar
$____- Preservation Award
Members receive:
- Kripplebush Schoolhouse Newsletter
- Free unlimited visits to the museum
- Voting privilege at annual meeting
Please print, mail & make your tax deductible checks payable to:
Kripplebush Schoolhouse Museum Inc.
PO Box 91
Stone Ridge, NY 12484
Your name will not be shared with other organizations.