Palmer Lake Historical Society
Year 2010 Membership/Renewal Form
Serving Palmer Lake, Monument & the Palmer Divide Since 1956

Memberships purchased in October through December include the next year; 2011

DUES:
$10.00 per year No. of individual memberships: Total: $
$15.00 per year No. of family memberships: Total: $
$25.00 per year Supporting, Individual or Family:  Total: $
$50.00 per year   Benefactor, Individual or Family:  Total: $
  TOTAL ENCLOSED: $

Please make checks payable to PLHS and mail to:

Palmer Lake Historical Society
P.O. Box 662
Palmer Lake, CO 80133

Name(s):

E-mail address:

Phone # (including area code):

Address:

City:

State:   Zip Code:

Please check if you are willing to serve in any of the following capacities:

Member of Board of Directors
Committee Member
Museum Docent
Meeting Greeter
Prepare meeting refreshments


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