Complete form online below, or print this page and mail your completed application with your check payable to The Portsmouth Historical Association, 221 North Street, Portsmouth VA 23704

Step One

Please fill in your information below.

Name

First Name

Last Name

Email Address

Checkbox

Choose your level of support:

Benefactor: $1000

Sponsor: $500

Donor: $100

Patron: $75

Sustaining: $50

Family: $35

Individual: $20

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

Country

(###)

###

####

Step Two

Your tax-deductible membership dues are a contribution towards conservation and operation of the Hill House Museum, as well as supporting the mission of the Portsmouth Historical Association. Click the button below to pay the membership fee.