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MEMBERSHIP FORM
(Membership year is from January 1 through December 31)
Please print this form and mail it with your dues to the address below.

NAME____________________________________________DATE_______________

ADDRESS_______________________________________________ZIP___________

TELEPHONE____________________________E-MAIL_______________________

ANNUAL DUES (please check appropriate line):

Student ($10) ________ Individual ($15) _______ Family ($20) _________

Sponsor ($25) __________Corporation ($50) ___________

Donation/Amount __________
Does your employer match your charitable donations?
Please remember EMHS in your giving.

Honorary members (residents of the area more than 50 years) do not pay dues.
Dues are tax deductible to the extent allowed by law.

Make checks payable to:

East Mountain Historical Society, P.O. Box 106, Tijeras, NM  87059


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