High Plains Historical Society Inc.

Membership Application
NAME:
ADDRESS:
CITY:
STATE:
ZIP:
PHONE:
Fill In Blanks, Print and Mail to:
High Plains Historical Society
775 3rd Street, P.O. Box 122
Nunn, Colorado 80648
Please make Check Payable To: High Plains Historical Society
Dues Extend to December 31 of the current year and are tax deductable.
Thank You For Your Support!!!
E-MAIL:
YOUTH ($2.00)
ADULT ($15.00)
COUPLE/FAMILY ($30.00)
SUPPORTING ($30.00)
BUSINESS ($100.00)
BENEFACTOR ($1000.00)