Newburgh Preservation Association
Dutch Reformed Church Restoration Committee
P.O. Box 206
Newburgh, NY 12551

Name __________________________________

Address _________________________________

City ____________________________________

State ____________ Zip ____________________

Email ___________________________________


Phone _________________ [ ] Days [ ] Evenings

Able to volunteer? _________________________


Skills/Area of interest ______________________

Please print this form, make check payable to:
Newburgh Preservation Association
and mail both to the address above.

All levels of support are gratefully appreciated!