Application to Join the Mendocino County Historical Society

Mendocino County Historical Society

An Invitation to Membership

To: Mendocino County Historical Society, 603 W. Perkins St. Ukiah, CA 95482

NAME: ________________________________________________________________

Address: _______________________________________________________________

Individual _____ @ $20.

Couple _____ @ $25.

Contributing _____ @ $35.

Patron _____ @ $100

Life Member _____ @ $300.

Couple Life ______ @ $500.

Enclosed is $_______ for payment of ______ years of membership dues.

*All dues, contributions and bequests are deductible under state and federal income tax provisions

Please print this form, fill in the necessary information, and mail with your payment to the address above.

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NAME: ________________________________________________________________

Address: _______________________________________________________________

Individual	_____	@ $20.
Couple	_____	@ $25.
Contributing	_____	@ $35.
Patron	_____	@ $100
Life Member	_____	@ $300.
Couple Life	______	@ $500.
Enclosed is $_______ for payment of ______ years of membership dues.