Membership Form
Douglas County Historical Society - Kansas
Please printout this page and mail it with payment to:
Douglas County Historical Society
1047 Massachusetts Street
Lawrence, KS 66044
Thank you
Membership Form
Name __________________________________________________________________
Street Address___________________________________________________________
City__________________State_______Zip_________Telephone __________________
e-mail address____________________________________________________________
CHECK ONE
Junior____________up to $15_______
Individual_____________ $25 _______
Family________________ $40 _______
Conservertor __________ $60 _______
Preserver_____________ $100 _______
Friend ________________ $250 _______
Sponsor_______________ $500_______
Patron_________________ $1,000_____
Benefactor______________ $5,000 _____
Allow 4 to 6 weeks to receive your membership card and membership information in the mail.