NAME:    First: Middle:
           Last:

If Family Membership,
additional Name(s):

Street Address:

City: State: Zip:

Area Code/Phone:

e-mail:

Membership Type: New Renewal

Classes of Memberships: (Please check one.)

Students and Seniors over 60 $10.00

Individual $25.00

Family $40.00

Historical Contributor $75.00

Patron $100.00

Sustaining $250.00