North Santiam Historical Society Membership Form

Membership: ($10 yearly includes four newsletters.  Over age 80, dues optional)

Please provide the following contact information:

Street Address
Zip/Postal Code

I enclose $ for (how many?) members

continuing membership(s)
new membership(s)
honorary member (80 years or older)

Contribution Opportunity

I also want to make a tax-deductible gift to:  (Please indicate amount)

$Canyon Life Museum
$the newsletter
$other (please specify)
$as needed
$in honor of

To print this form, right-click and select "print", then mail to:      

North Santiam Historical Society
PO Box 574
Gates, OR   97346

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