MEMBERSHIP FORM for
GORE PLACE the Federal period historic house and estate in Waltham, MA
Please fillout, print and mail this form, along with check, money order (no cash please) or VISA, Mastercard, Discover Card or AmEx information. Mail to:
Gore Place, 52 Gore Street, Waltham, MA 02453-6866
Please fill in your name and address:

First Name:    Last Name:

Address:

    City: State: Zip Code:

Email Address:

Phone Number (if paying by credit card):

Please BEGIN RENEW my Gore Place Society membership in the category checked below.

$35 Kids Club
$35 Wal/Wat Resident
$40 Individual
$50 Family
$100 Friends of the Farm
$250 Friends of the Mansion
$500 Rebecca Gore Society
$1,000 Christopher Gore Society

 


Please indicate method of payment: Credit Card Check/Money Order

Credit Card Number Expiration Date:

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