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