PRINT AND MAIL
MEMBERSHIP FORM
Membership is for a year once you pay your dues
MEMBERSHIP FORM (Please print)
Yes! I wish to join the Society that preserves the past and celebrates our heritage.
Name __________________________________________________________
Address ________________________________________________________
City ___________________________________________________________
State ____________________ Zip ___________ Email __________________
Home Phone ___________________ Cell Phone_______________________
Check type of membership: ______ Regular ($35.00) ______ Household ($50.00)
_______Patron ($75.00) ______ Renovator ($100.00) _______ Heritage Education Sustainer ($150.00 +)
GIFT MEMBERSHIP (Please print)
_____ $ Gift Membership for someone I know who will benefit from membership.
(Photocopy this form for more than one. Use rates listed above.)
Name _________________________________________________________
Address ________________________________________________________.
City ___________________________________________________________.
State ____________________ Zip ___________ Email __________________.
VOLUNTEER for a COMMITTEE
[ ] Nominations [ ] Membership [ ] Publications
[ ] Annual Meeting/Socials [ ] Preservation [ ] Public Relations
[ ] Landmark Preservation Committee [ ] Education/Communications
Name _________________________________________________________
(Make checks to "Shawnee County Historical Society")
Please send form(s) with your check to:
Shawnee County Historical Society, P.O. Box 2201, Topeka, KS 66601-2201