To become a member complete this form and click "Submit"

  *First Name                        *Last Name                                Title
      Mr. Ms. Mrs.
  Spouse's Name
  
  Names & Ages of Minor Children
  
  *E-mail Address
     
  *Mailing Address
   
  City                                             State                     Zip Code
    Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington, DC West Virginia Wisconsin Wyoming   

  Phone Number:
    *Home    Work 
  Please call me. 

My interest in local history includes the following:


I am interested the following appointments/positions:
 Officer of Organization
 Nominating Committee
 Public Relations Committee
 Finance Committee
 Publications Committee
 Budget Committee

I would like to volunteer for the following activities:
 Pineapple Patch Gift Shop
 History Fair
 Zora Fest
 Santa Lucia Day
 Sandy Shoes Festival
 Party in the Park
 FL Cracker Trail Day
 Pioneer Brunch
 Christmas Parade
 Fundraising
 Monthly Programs
 Search for permanent office/meeting facility
 Calendar
 Newsletters
 Research (Type:)
 Archive
 Website management

Type of membership:  New      Renewal

  Individual Membership - $15.00 per year
  Family Membership - $20.00 per year
  Small Business Membership - $50.00
  Corporate Membership - $100.00 per year


  *Required Fields