On-Line 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 __________________. Check type of membership:      ______ Regular—$35.00  ______ Patron—$50.00                                                      ______ Renovator—$100.00

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