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| Please enter my membership in Etowah Valley Historical Society as follows: |
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| ___Individual...................................... | $15.00 |
| ___Family.......................................... | $20.00 |
| ___Club or Organization..................... | $30.00 |
| ___Corporate or Patron..................... | $100 or more |
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| I would like to make a tax-deductable donation to EVHS in the amount of $_________________ |
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| Name(s)____________________________________________________________________ |
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| Corporate Name______________________________________________________________ |
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| Address_____________________________________________________________________ |
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| City and State____________________________________________Zip__________________ |
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| Phone____________________________Email_______________________________________ |
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| Please have someone contact me about volunteering for__________________________________ |