PLATTE COUNTY, MISSOURI,  HISTORICAL AND GENEALOGICAL SOCIETY

 

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Membership Application Form

Print this form, fill-in the information, and mail with your check (payable to Platte County Historical Society) to:

Platte County Historical Society

Membership Application

P. O. Box 103

Platte City, MO  64079-0103

Membership cards available when self-addressed, stamped envelope is enclosed with dues

 

Please circle:    Mr.     Mrs.     Ms.     Dr.

Name: _________________________________________________

                 First                                  MI                                    Last

Address: _______________________________________________

City: _______________________ State: ______  Zip: ____________

Home Phone: ____________________________________________

Work Phone: ____________________________________________

E-Mail Address: __________________________________________

 

ANNUAL MEMBERSHIP FEES   Check a category

P

Individual

$21.00

 
Family

$32.00

 
Student (currently registered)

$1.00

 
Corporate/Commercial

$50.00

 
LIFE MEMBERSHIP
Age 1 - 55 years

$400.00

 
Age 56 - 75 years

$300.00

 
Age over 75 years

$100.00

 
CONTRIBUTING DONOR ANNUAL MEMBERSHIP
Contributor

$50.00 - $99.00

 
Sustaining

$100.00 - $149.00

 
Supporting

$150.00 - $199.00

 
Ambassador

$200.00 - $499.00