Derby Historical Society

Founded April 18, 1946 to serve the Naugatuck Valley towns of Ansonia, Derby, Oxford, Seymour & Shelton

“Celebrating a Proud Past and a Promising Future”

2012 Membership Application

Membership dues may be left with the Staff at the Gen. David Humphreys House at 37 Elm Street Ansonia during regular business hours or sent to:

Derby Historical Society

PO Box 331

Derby, CT 06418

Categories of Membership:

* Life $150.00

Contributing $30.00

Name

Address

E-mail (if applicable)

Please send a membership invitation to:

Name

Address

Simply print this form and return it with your check made out to: Derby Historical Society.

* Note – If you already are a Life Member, please disregard. However, the Derby Historical Society

will appreciate any ongoing support you may feel is appropriate.

Thank you for your support!