MORONGO BASIN HISTORICAL SOCIETY

P.O. Box 2046

Yucca Valley, California 92286

MEMBERSHIP APPLICATION

Membership Categories:                      (check one)     

    Individual            -           $20 per year            

   Family (1 address)     -      $35 per year            

   Business/Organization  -  $35 per year           

   Life (1 person)          -       $300 (eff 7-1-04)     

Membership year is from July 1 thru June 30

After January 1, membership rate is 1/2 dues amount, except for Life

*Please make your check out to:  Morongo Basin Historical Society or MBHS*

MAIL TO:   MBHS, P.O. Box 2046, Yucca Valley, California 92286

Today's Date: 

NAME (First & Last): 

Additional Name If a "Family Membership":  

Residence Address: 

Mailing Address, if different from above:

Telephone Number:      

E-Mail Address: 

I/We wish to give an additional None $5.00 $10 $15 $25 $50 $100 Other as my tax-deductible donation to the Morongo Basin Historical Society.  Your gift is sincerely appreciated.  (Other Amount: )

*This form can be completed, printed out, and mailed with your check  to the above address   

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