Healdsburg Museum & Historical Society

Membership Form

Membership
Membership Form

Name	________________________________________
Business Name	________________________________________
Address	________________________________________
City	________________________________________
State & Zip Code	________________________________________
Phone	(____) _______________
Date	_______________
Email Address _____________________________________
Please check the volunteer activities that interest you:
receptionist		oral history
community outreach		research
computer work		other _{______________________}

	New member Renewal
Membership categories:
Harmon Heald	$1,000+		Family (2 or more)	$40
Josefa Carrillo	$500		Individual	$25
Edwin Langhart	$250		Business	$75
Gold	$100

Additional donation to Endowment Fund $____________________
Make checks payable to Healdsburg Museum & Historical Society (HM&HS)

Print this form, fill it out and send with payment to: Healdsburg Museum, P.O. Box 952, Healdsburg, CA 95448