TULSA HISTORICAL SOCIETY MEMBERSHIP

Name ___________________________________________________
Address_________________________________________________
City____________________ State_______ Zip+4________________
Telephone______________________ Fax______________________
E-Mail address ___________________________________________
Support Categories
□ Recognition ($1,000 or more) □ Sustaining ($500) □ Supporting ($100)
□ Family ($50) □ Individual ($35)
□ Check □ VISA □ MasterCard
Card Number __________________________________________
Expiration Date____________________
Your membership is fully tax-deductible, ID # 73 079 5545
Mail to: Tulsa Historical Society, 2445 S Peoria, Tulsa, OK 74114-1326