Application to join the Galt Area Historical Society

Galt Area Historical Society, Inc.
Attn. Pam Lamkin
P O box 782
Galt, CA. 95632
209-745-0951

I am interested in becoming a member of the Galt Area Historical Society as an active ( ) or Support ( ) member.

Individual ________ $20.00 Individual Lifetime ________ $100.00

Family ________ $40.00 Family Lifetime ________ $200.00

Student ________ $10.00 (under 25 with proof of enrollment)

Business or Corp. _________ $50.00

Renewal Membership ______________ New Membership _____________

Membership Dues are Tax Deductible

Name ________________________________________________________ Date______________________

Address _____________________________________________________
City _______________________

State _________ Zip Code ______________ Phone________________

Email address______________________________________________

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