2008 Donation / Membership Form page 2
Section A: To renew or purchase a membership:
First, check a category. Then, fill out your contact information, please.
(or place one of your return address labels over that area)
_____Individual $35.00 Name:___________________________
_____Family $40.00 Address:_________________________
_____Institutional- $50.00 City/St./Zip:_______________________
_____Supporting $75.00 Telephone: (______) ______-________
Section B: See the gift membership form on page 1.
Section C: **I would like to show my additional support in the amount of $________
Is this in memory of someone? If so, please list the name(s) here:
____________________________________________________________
Which fund would you like this gift to go in?
_____General Operating Fund
(helps with preservation, FREE school tours, maintenance, etc.)
_____Building Fund
(we will soon be expanding to better serve you)
_____Special Events
(Education is key. We hold fun events to help build awareness
about Buffalo County’s past)
************************************************************************************************************************
Total:
$______________From Section A (membership renewal)
$______________From Section B (gift membership)
+ $______________From Section C (additional support)
Your total: $______________
************************************************************************************************************************
Please mail this form in with your check or money order to:
Buffalo County Historical Society/Trails and Rails Museum
PO Box 523, 710 W. 11th St., Kearney, NE 68848
bchs@bchs.us www.bchs.us (308) 234-3041
Thank you! We appreciate your support!