PRINT AND MAIL
MEMBERSHIP FORM
Membership is from January-December, annually

 

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)  ______ Patron ($50.00)                                              ______ 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