Please print the form, complete and send check or money order to:

Anoka County Historical Society

2135 Third Avenue North

Anoka, MN  55303-2421

 

For more information email: theresa@ac-hs.org

 

 

 

                                                   MASTER and VISA accepted

 

 

 

MEMBERSHIP

Date: ___________________

Name(s):________________________________________________

Address: ________________________________________________

City, State & Zip: _________________________________________

Home Phone:  ( _________ ) ________________________________       

Work Phone:  ( __________ ) _______________________________  

Email (Optional) __________________________________________

Special Interests and Skills: _________________________________

_______________________________________________________

If you are gone for an extended period during the year, please provide your “other” address, if available,” with the month of departure and month of return.   Departure month: ____________ Return month: _______________

Other address:_________________________________________________

City, State & Zip: _______________________________________________

Annual Membership Dues

                        ____ Family                                     $25.00

                        ____ Individual                                $ 15.00

                        ____ Senior Citizen (62+)               $  7.00

                        ____ Student (6-17)                         $  7.00

                       

MEMBERSHIP DUES                                            $ _____________

To further support ACHS in preserving Anoka County history,

ENCLOSED IS A DONATION OF:                      $ _____________

TOTAL AMOUNT ENCLOSED:                           $ ____________

 

Thank you for your support!  

Method of Payment:

Check enclosed payable to The Anoka County Historical Society _____

Or charge to:   ___MasterCard     ____Visa

Account#:  __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __

Expiration Date:  __ __ Mo.  - __ __ Yr.

Signature: ______________________________________________________________

 

If you would prefer that we NOT share your name with other like-minded organizations, please check here:  ___________