I am
a... ____ New Member ____Renewing Member
I would like to make a donation in the amount of $_______
The Historical Society
is a nonprofit organization under Sec. 501 C (3) of the Internal
Revenue Code 71954. Gifts and legacies are tax deductible.
Name_________________________________________________________
Street Address__________________________________________________
City___________________________________________________________
State__________________________________________________________
Zip Code_______________________________________________________
Phone_______________________________________________________
Email_______________________________________________________
Please check the appropriate space next to the
membership for which you would like to sign up.
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