Please print this page, fill in the blanks and mail to

Douglas County Historical Society

1477 Hwy 395 N, Suite B

Gardnerville, NV 89410-5214

Please include your Membership Dues.

ANNUAL MEMBERSHIP DUES

___ $30 Individual

___ $40 Family (Parents & Children 17 and under)

___ $20 Senior Individual (65+)

___ $30 Senior Couple (65+)

___ $ 500 Lifetime Individual

___ $ 750 Lifetime Couple

Name: ________________________________________

Mailing Address: ________________________________

______________________________________________

E-mail Address: _________________________________

Phone (______)_______-_______

Contact me for volunteer options ___