Historical Society Application for Membership

APPLICATION FOR MEMBERSHIP

(Please print)

Name: ___________________________________________________

Address: _________________________________________________

City: ___________________ State ______ Zip __________

Phone: ____________________________

MEMBERSHIP CATAGORY (Check appropriate box)

___ $10 FRIENDS OF THE SOCIETY (Annual Dues)

___ $100 LIFETIME SUSTAINING **

**A partial payment & pledge of membership is available.  $25 initial payment with the remaining $75 in 3 annual $25 payments.

Send application & check or money order to:

A membership card will be forwarded to you.