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              MEMBERSHIP RENEWAL/APPLICATION

           Curry Historical Society
          P.O. Box 1598 * 29419 Ellensburg Ave.
                Alice Wakeman Memorial Building              
                   Gold Beach, OR  97444                            
                (541) 247-6113 or 247-9396 
                      www.curryhistory.com    hissoc@gb.wave.net

 

 

Date of renewal or application: Period from:_____________ to _____________                         

                                               

Membership provides FREE ACCESS TO MUSEUM * QUARTERLY NEWSLETTER * 10% DISCOUNT ON BOOK PURCHASES

 PLEASE RENEW BY JANUARY 31st ANNUALLY

Check applicable selections:                Renewing Member__________                            New Member_______________

Regular Membership                  Sponsorship Program                         Lifetime Membership

_____  Adult    $20 yr                   _____  Business $25 yr                            For Individuals Only

_____  Student $10 yr                 _____  Sponsor $100 - $499 yr                ____Under 50 yrs of age $150

_____  Family   $30 yr                 _____  Patron $500 - $1,000 yr               _____50 yrs and over $125
SELF:                                                GIFT:

Name  ______________________________          Name ______________________________

Mailing Address_____________________          Mailing Address_____________________

City________________________________                    City_________________________________

State______________  Zip_____________          State______________ Zip_______________

Telephone  (_____)__________________                  Telephones  (_____)__________________

email ______________________________                    email _______________________________

(CONTRIBUTIONS ARE TAX DEDUCTIBLE)