Membership Form

Please complete this form, print it and mail it with your payment to:

Preservation League of New York State
44 Central Ave
Albany NY 12206

Name:
Address:
City, State, Zip:
Phone:
Fax:
Email:

Annual Membership Categories

$1,000 Pillar

$500 Pediment

$250 Capital

$100 Keystone

$50 Foundation

$35 Bricks and Mortar

Other: $

Method of Payment

Check, made payable to the Preservation League of New York State
Credit Card

MC VISA AMEX

Name
as it appears on card:
Card Number:
Expiration Date:
Amount:
Signature:

Please print this form and mail it to the Preservation League. Do not send credit card information via e-mail, as this is not a secured site.

Thank you for your membership! The League depends upon your support to carry out its many programs to protect the state’s historic buildings, districts and landscapes.

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