IRVING HERITAGE SOCIETY
MEMBERSHIP APPLICATION & CONTRIBUTION FORM
Are you joining the Irving Heritage
Society for the first time? Yes___ No____
____Enclosed are my membership dues for the period June to
May:
_____ Regular Member (Individual) $15.00 _____ (Family) $25.00
_____ Senior Citizen
(Individual) $10.00 _____ (Family) $15.00
_____ Student
(Individual) $5.00
_____ Corporate Member
$200.00
____ Enclosed is my one-time fee for Life Membership:
____ (Individual] $150.00 ____ (Family) $250.00
Name
_____________________________________________________________________________
Street Address
____________________________________________________________________
City ___________________________________State
_________________Zip_________________
Mailing Address
__________________________________________________________________
City
___________________________________State _________________Zip_________________
Telephone -
Res.___________________________ Bus.__________________________________
E-mail Address
___________________________________________________________________
===================================================================
____ Enclosed is a contribution of
$_________________________________________________
Please
check as appropriate ____ In memory of ______________________________
____ In honor of ________________________________
____ On the occasion of _________________________
___________________________________________
Please send acknowledgment card to:
Name
_____________________________________________________________________________
Street Address
____________________________________________________________________
City ___________________________________State
_________________Zip_________________
Print this form and mail, with your
check, to:
Irving Heritage Society
P.O. Box 171572
Irving, TX 75017-1572