Membership Form

Here is the membership form. Just print out and send.

Shirley-Eustis House Association, 33 Shirley Street, Roxbury, MA 02119

I accept your invitation to become a member of the Shirley-Eustis House Association.

Name: __________________________________________________________

Address: ________________________________________________________

_______________________________________________________________

Telephone: ( ______ ) ____________________ Date _______________

Enclosed is my check for:

____ $25 ...... Member

____ $40 ...... Family Membership

____ $100 .... Business/Organization

____ $250 .... Charter Member

____ $500 .... Governors' Club

I would also like to make a tax-deductible contribution of $_______
to go toward the maintenance and operation of the Shirley-Eustis House.

Please make your check payable to the Shirley-Eustis House Association.