Douglas County Historical Society

Membership Form

*Fields marked with asterisks are required.

Personal Information

*First Name
MI
*Last Name
*Address
Address Two
*City
*State
*ZIP
*Telephone
*E-mail

Membership Information

Please select the type of membership in which you wish to enroll.

Basic Membership

Membership TypeAmount
$15
$30
$40
$60

Enhanced Membership

Membership TypeDonation RangeAmount
$100–$249$ .00
$250–$499$ .00
$500–$999 $ .00
$1,000–$2,499 $.00
$2,500 $4,999 $ .00
$5000+ $ .00
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